Frings Jannik, Krause Matthias, Akoto Ralph, Frosch Karl-Heinz
Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany.
J Knee Surg. 2019 Sep;32(9):924-933. doi: 10.1055/s-0038-1672125. Epub 2018 Oct 3.
The purpose of this study is to analyze the clinical results after treatment of patellofemoral instability and maltracking caused by torsional or axial deformities of the lower extremity by combined distal femoral osteotomies (DFOs). We analyzed 31 DFOs (25 patients) with patellar maltracking and instability, treated in our clinic. Torsional angles and the leg axis in the frontal plane were measured preoperatively. Standardized scoring systems were determined pre- and postoperatively including a clinical examination. Nineteen cases of torsional and 12 cases of axis deformities were evaluated 27 (12-64) months postoperatively. Among those with torsional deformity, mean femoral torsion was -39.0 ± 8.8 degrees, tibial tuberosity to trochlear groove (TT-TG) 20.3 ± 4.5 mm. We performed 19 torsional (+11.4 ± 2.4 degrees) DFOs with medial patellofemoral ligament (MPFL) augmentation ( = 19), tibial tuberosity transfer ( = 14, 10.9 ± 6.0 mm), varus ( = 4, 3.3 ± 1.0 degrees), or valgus ( = 1, 7.0 degrees) correction. Among valgus deformities, the leg axis was 6.7 ± 2.3 degrees valgus and TT-TG 19.3 ± 5.0 mm. We performed 12 medially closing-wedge DFOs (7.6 ± 2.8 degrees) with MPFL augmentation ( = 12) and tibial tubercle transfer ( = 9, 11.4 ± 7.3 mm). Visual analogue pain scale improved from 6.2 to 1.5 ( = 0.000), Kujala score from 45.0 to 81.5 ( = 0.000), Lysholm score from 40.3 to 83.9 ( = 0.000), and Tegner score from 2.1 to 3.9 ( = 0.000). Preoperative cartilage damage significantly influences the postoperative functional outcome (Lysholm score) ( = 0.026) as well as the improvement in terms of the Kujala score ( = 0.045) in the overall collective. No redislocation was observed. Patellofemoral maltracking and instability in torsional and axis deformities can successfully be treated by combined DFOs with excellent clinical results. The coexistence of risk factors for patellar instability requires a combination of additional procedures to complement the osteotomy. Preoperative cartilage lesions significantly influence the clinical outcome.
本研究的目的是分析通过联合股骨远端截骨术（DFO）治疗下肢扭转或轴向畸形引起的髌股关节不稳定和轨迹不良后的临床结果。我们分析了在我院接受治疗的31例因髌骨轨迹不良和不稳定而进行DFO的患者（共25例）。术前测量扭转角度和额状面下肢力线。术前和术后采用标准化评分系统，包括临床检查。术后27（12 - 64）个月对19例扭转畸形和12例力线畸形患者进行评估。在扭转畸形患者中，平均股骨扭转角度为-39.0±8.8度，胫骨结节至滑车沟（TT - TG）距离为20.3±4.5 mm。我们对19例扭转畸形（+11.4±2.4度）患者进行了DFO，同时进行内侧髌股韧带（MPFL）增强术（n = 19）、胫骨结节转移术（n = 14，10.9±6.0 mm）、内翻（n = 4，3.3±1.0度）或外翻（n = 1，7.0度）矫正。在外翻畸形患者中，下肢力线为外翻6.7±2.3度，TT - TG为19.3±5.0 mm。我们对12例内侧闭合楔形DFO（7.6±2.8度）患者进行了MPFL增强术（n = 12）和胫骨结节转移术（n = 9，11.4±7.3 mm）。视觉模拟疼痛评分从6.2改善至1.5（P = 0.000），Kujala评分从45.0提高至81.5（P = 0.000），Lysholm评分从40.3提升至83.9（P = 0.000），Tegner评分从2.1增至3.9（P = 0.000）。术前软骨损伤对总体人群的术后功能结果（Lysholm评分）（P = 0.026）以及Kujala评分的改善情况（P = 0.045）有显著影响。未观察到再脱位情况。扭转和力线畸形引起的髌股关节轨迹不良和不稳定可通过联合DFO成功治疗，临床效果良好。髌股关节不稳定危险因素的共存需要联合其他手术来补充截骨术。术前软骨损伤显著影响临床结果。
