混合高位胫骨截骨术优于内侧开放高位胫骨截骨术治疗伴髌股关节炎的内翻膝。
Hybrid high tibial osteotomy is superior to medial opening high tibial osteotomy for the treatment of varus knee with patellofemoral osteoarthritis.
机构信息
Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Apr;27(4):1332-1338. doi: 10.1007/s00167-018-5015-2. Epub 2018 Jun 8.
PURPOSE
To evaluate patellofemoral congruity after opening wedge high tibial osteotomy (OWHTO) and hybrid HTO.
METHODS
Twenty-four knees with hybrid HTO and 24 with OWHTO were evaluated in this study. The Caton-Deschamps and modified Miura-Kawamura indices were used to evaluate pre- and post-operative patellar heights for both types of surgery. Tibial tuberosity-trochlear groove (TT-TG) distance, patellar tilt, and medial and lateral joint space at the patellofemoral joint were compared. Anterior knee pain was assessed using the Kujala anterior knee pain scale.
RESULTS
There was no significant difference between the correction angles of the hybrid HTO and OWHTO. Pre- and post-operative values for the Caton-Deschamps and modified Miura-Kawamura indices in patients who underwent hybrid HTO changed from 0.90 to 0.94 and from 0.95 to 1.03, respectively, with no significant differences noted. Following OWHTO, these values decreased significantly from 0.91 to 0.73 and from 1.06 to 0.84, respectively (p < 0.01). The post-operative patellar height after OWHTO was significantly lower than that after hybrid HTO (p < 0.01). After hybrid HTO, the TT-TG distance decreased significantly from 11.4 to 7.4 (p < 0.01), but it did not change significantly after OWHTO. Although pre- and post-operative patellar tilt were not altered significantly in either group, the medial joint space of the patellofemoral joint was significantly increased post-operatively following hybrid HTO (p = 0.035). The pre-operative Kujala scores were significantly lower in the hybrid HTO group, but post-operative scores improved in both groups.
CONCLUSIONS
Hybrid HTO provides a better post-operative patellofemoral joint than does OWHTO with regard to patellar position and reduction of the TT-TG distance, as well as improved clinical outcomes. Hybrid HTO, rather than OWHTO, is the preferred technique for the treatment of varus knees combined with patellofemoral osteoarthritis.
LEVEL OF EVIDENCE
Retrospective comparative study, Level III.
目的
评估开放楔形胫骨高位截骨术（OWHTO）和混合 HT0 术后髌股关节吻合度。
方法
本研究评估了 24 例混合 HT0 和 24 例 OWHTO 患者。使用 Caton-Deschamps 和改良 Miura-Kawamura 指数评估两种手术前后的髌骨高度。比较胫骨结节-滑车沟（TT-TG）距离、髌骨倾斜度以及髌股关节的内侧和外侧关节间隙。采用 Kujala 膝关节前痛量表评估膝关节前痛。
结果
混合 HT0 和 OWHTO 的矫正角度无显著差异。混合 HT0 患者的 Caton-Deschamps 和改良 Miura-Kawamura 指数术前值从 0.90 变为 0.94，术后值从 0.95 变为 1.03，无显著差异。OWHTO 术后，这些值分别显著从 0.91 变为 0.73 和从 1.06 变为 0.84（p<0.01）。OWHTO 术后的髌骨高度明显低于混合 HT0（p<0.01）。混合 HT0 后 TT-TG 距离显著从 11.4 变为 7.4（p<0.01），OWHTO 后无显著变化。虽然两组髌骨倾斜度术前和术后均无明显变化，但混合 HT0 后髌股关节内侧关节间隙明显增大（p=0.035）。混合 HT0 组术前 Kujala 评分明显较低，但两组术后评分均有所改善。
结论
混合 HT0 术后髌股关节吻合度优于 OWHTO，可改善髌骨位置和 TT-TG 距离，临床疗效更好。混合 HT0 而非 OWHTO 是治疗伴髌股关节炎的内翻膝的首选技术。
证据水平
回顾性比较研究，III 级。
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