1° Clinica Ortopedica ASST G. Pini-CTO - UOS Chirurgia Articolare del Ginocchio, Piazza A. Cardinal Ferrari 1, Milan, 20122, Italy.
Knee Surg Sports Traumatol Arthrosc. 2020 Dec;28(12):3955-3961. doi: 10.1007/s00167-020-05890-0. Epub 2020 Feb 13.
The purpose of this study was to analyze the long-term clinical and radiological outcomes of patients who underwent closing-wedge High Tibial Osteotomy (HTO) for the treatment of medial compartment osteoarthritis and to evaluate the conversion rate to knee arthroplasty.
A retrospective, non-randomized, monocentric study was performed in our Institution considering 166 patients between 1989 and 2012. The final population was composed by 82 patients (94 knees), median age at time of operation was 53 (range 45-73) years. All patients were evaluated clinically (HSS Score, Tegner Scale, VAS and Crosby-Insall Grading) and radiographically (osteoarthritis staging, hip-knee-ankle (HKA) angle, tibial slope and metaphyseal varus).
Mean follow-up was 11.9 ± 7.2 years. HSS Score increased significantly from 70.8 ± 10 to 93.2 ± 9.1 (p < 0.05) instead Tegner Scale increased from 1.3 ± 0 (range 1-4) to 2.8 ± 0.7 (range 2-6) at the last control (n.s.); VAS score significantly decreased from 7.9 ± 1.4 to 1.6 ± 1.1 (p < 0.05) at last follow-up. According to the Crosby-Insall Grading System, 80 patients (97.4%) reported excellent-good results. HKA angle decreased from 6.9° ± 3.5 to 2.6° ± 2.6 (p < 0.01), tibial slope decreased from 10.1° ± 1.4 to 6.8° ± 2.1 (p < 0.05) and finally the metaphyseal varus decreased from 4.2° ± 0 to 2.1° ± 1.2 (n.s.) at the last follow-up. Adverse events were reported in 4.8%. Osteotomy survivorship rate resulted 92% at 10 years, 82% at 15 years and 80% at 20 years. Sixteen revisions (9.6%) were reported at a mean period of 12.8 years.
CW-HTO is a valid option for medial osteoarthritis treatment, with successful results in both clinical and radiological outcomes.
IV.
本研究旨在分析接受闭合楔形胫骨高位截骨术（HTO）治疗内侧间室骨关节炎患者的长期临床和影像学结果，并评估其向膝关节置换术的转化率。
本研究为回顾性、非随机、单中心研究，纳入了 1989 年至 2012 年间的 166 例患者。最终纳入 82 例患者（94 膝），手术时的中位年龄为 53 岁（范围 45-73 岁）。所有患者均进行临床评估（HSS 评分、Tegner 量表、VAS 评分和 Crosby-Insall 分级）和影像学评估（骨关节炎分期、髋膝踝（HKA）角、胫骨倾斜度和干骺端内翻）。
平均随访时间为 11.9±7.2 年。HSS 评分从 70.8±10 显著提高至 93.2±9.1（p<0.05），而 Tegner 量表从 1.3±0（范围 1-4）增加至 2.8±0.7（范围 2-6）（n.s.）；VAS 评分从 7.9±1.4 显著降低至 1.6±1.1（p<0.05）。根据 Crosby-Insall 分级系统，80 例患者（97.4%）报告结果为优秀或良好。HKA 角从 6.9°±3.5 减少至 2.6°±2.6（p<0.01），胫骨倾斜度从 10.1°±1.4 减少至 6.8°±2.1（p<0.05），最后干骺端内翻从 4.2°±0 减少至 2.1°±1.2（n.s.）。最后随访时，有 4.8%的患者出现不良事件。10 年、15 年和 20 年的截骨存活率分别为 92%、82%和 80%。16 例（9.6%）患者在平均 12.8 年时进行了翻修。
CW-HTO 是治疗内侧骨关节炎的有效选择，在临床和影像学结果方面均取得成功。
IV 级。
