van Wulfften Palthe A F Y, Clement N D, Temmerman O P P, Burger B J
Department of Orthopaedics, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, 51 Little France Dr, Edinburgh, EH16 4SA, UK.
Eur J Orthop Surg Traumatol. 2018 Oct;28(7):1381-1389. doi: 10.1007/s00590-018-2199-6. Epub 2018 Apr 12.
The primary aim of this study was to identify independent predictors of long-term survivorship after high tibial osteotomy (HTO). The secondary aims were to describe the functional outcome of surviving HTO 10-20 years after surgery.
A retrospective cohort of 223 HTO that were performed for the treatment of medial osteoarthritis was identified. Details were recorded from the patient notes. All surviving patients were contacted and asked to complete a Tegner Activity Scale, Lysholm Knee Score and rate pain using the Visual Analogue Scale (VAS). Survival analysis was performed, using conversion to arthroplasty as the definition of failure.
The mean age was 54 years (24-80 years). There were 123 (55.2%) in males and 100 (44.8%) in females. The mean BMI was 27.2 (SD 3.9). Twenty (9%) patients were lost to follow-up. The mean follow-up was 12 (SD 4) years. Survival at 10 years was 75 and 55% at 15 years and less than 40% at 20 years. Cox regression analysis demonstrated age of 50 years or more, female gender and surgical technique to be significant independent predictors of failure. The median Tegner score was 3 (inter-quartile range (IQR) 1-3). The mean Lysholm score was 75.5 (SD 18.4). The median VAS was 5 (IQR 0-6).
The medium- to long-term survival and functional outcome after HTO was good to excellent at 10-20 years of follow-up. Age, gender, surgeon and surgical technique were identified as independent predictors of failure.
本研究的主要目的是确定高位胫骨截骨术（HTO）后长期生存的独立预测因素。次要目的是描述手术后10 - 20年存活的HTO患者的功能结局。
确定了一个回顾性队列，其中包括223例因治疗内侧骨关节炎而进行的HTO手术。从患者病历中记录详细信息。联系了所有存活患者，要求他们完成Tegner活动量表、Lysholm膝关节评分，并使用视觉模拟量表（VAS）对疼痛进行评分。进行生存分析，将转换为关节成形术作为失败的定义。
平均年龄为54岁（24 - 80岁）。男性123例（55.2%），女性100例（44.8%）。平均体重指数为27.2（标准差3.9）。20例（9%）患者失访。平均随访时间为12年（标准差4年）。10年生存率为75%，15年生存率为55%，20年生存率低于40%。Cox回归分析表明，年龄50岁及以上、女性性别和手术技术是失败的重要独立预测因素。Tegner评分中位数为3（四分位间距（IQR）1 - 3）。Lysholm评分平均为75.5（标准差18.4）。VAS中位数为5（IQR 0 - 6）。
在10 - 20年的随访中，HTO术后的中长期生存和功能结局良好至优秀。年龄、性别、外科医生和手术技术被确定为失败的独立预测因素。
