Akiyama Takenori, Osano Kei, Mizu-Uchi Hideki, Nakamura Norimasa, Okazaki Ken, Nakayama Hiroshi, Takeuchi Ryohei
Kyushu Around Knee Osteotomy Research Group, Fukuoka, Japan.
Akiyama Clinic, Fukuoka, Japan.
Arthrosc Tech. 2019 Jun 2;8(6):e655-e662. doi: 10.1016/j.eats.2019.02.011. eCollection 2019 Jun.
Open-wedge high tibial osteotomy is considered to be an effective surgical intervention for medial compartmental knee osteoarthritis. However, patella infra, which has been reported to be a result of tuberosity distalization after open-wedge high tibial osteotomy, changes the native patellofemoral biomechanics. This could raise abnormal patellofemoral contact stresses, which might be the trigger of patellofemoral arthrosis. To minimize the reduction in patellar height, we have developed a technique called open-wedge distal tuberosity tibial osteotomy. The benefits of this technique include increased bone-to-bone contact of the distal tuberosity cut surface after correction by cutting an arc osteotomy around the hinge position, which is the center of rotation. This technique also provides cortical support at the anterior osteotomy site without additional bone defect and, therefore, may be advantageous against weight-bearing stress on the osteotomy site. In all, open-wedge distal tuberosity tibial osteotomy could potentially be a unique open-wedge osteotomy that eliminates the risk for postoperative patellofemoral osteoarthritis and also could theoretically encourage rapid healing of the osteotomy, which could lead to early return to full physical activity.
开放楔形高位胫骨截骨术被认为是治疗膝关节内侧间室骨关节炎的一种有效手术干预方法。然而，据报道，开放楔形高位胫骨截骨术后由于结节远移导致的髌下改变，会改变原有的髌股生物力学。这可能会增加异常的髌股接触应力，而这可能是髌股关节病的触发因素。为了尽量减少髌骨高度的降低，我们开发了一种名为开放楔形远端结节胫骨截骨术的技术。该技术的优点包括通过在作为旋转中心的铰链位置周围进行弧形截骨矫正后，增加远端结节截骨面的骨对骨接触。该技术还在前侧截骨部位提供皮质支撑，而无需额外的骨缺损，因此，可能有利于抵抗截骨部位的负重应力。总之，开放楔形远端结节胫骨截骨术可能是一种独特的开放楔形截骨术，可消除术后髌股骨关节炎的风险，并且理论上还可促进截骨的快速愈合，从而使患者能够早日完全恢复体力活动。
