Bayam Levent, Erdem Mehmet, Gülabi Deniz, Erdem Ahmet Can, Uyar Ahmet Çağrı, Kochai Alauddin
Department of Orthopaedics and Traumatology, Sakarya University, School of Medicine, Sakarya, Turkey.
Department of Orthopaedics, Bahçeşehir University, School of Medicine, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2020 Jan;54(1):89-96. doi: 10.5152/j.aott.2020.01.130.
The aim of this study was to assess the clinical and radiological results of our high tibial osteotomy technique combining fixator-assisted nailing and subtubercle tibial osteotomy in varus malalignment.
This was a retrospective study of a consecutive series of 32 knees in 32 patients ('2 follow-up loss' 12 males and 18 females; mean age at the time of operation: 50.6±7.8 (36-62) years) operated on between 2014 and 2016. Radiographic and clinical measurements were assessed pre- and postoperatively. Kolmogorov-Smirnov, paired t and Wilcoxon rank tests were used in the statistical analyses.
The mean follow-up period was 36.1±8.15 (31-53) months, the mean duration of the hospital stay was 3.6±0.1 (2-6) days, and the mean Kellgren-Lawrence score was 2.4±0.6 (2-4). Time to bony union was an average of 16.17 (12-29) weeks. Compared to the preoperative mechanical medial proximal tibial angle, femorotibial angle and mechanical axis deviation measurements, all the postoperative values showed significant changes (p<0.01). However, there was no statistical difference between the preoperative and postoperative tibial slopes (p>0.05), and the postoperative Caton-Deschamps index did not show a meaningful change (p>0.05). The postoperative visual analog scale, Knee Society Score, and Modified Hospital for Special Surgery Knee Scoring System measures showed significant improvement compared to the preoperative values (p<0.01). The postoperative walking distance increased to 1137.50±845.1 meters, from 359.4±306.2 meters (p<0.01).
This percutaneous technique is minimally invasive, corrects the alignment in two planes, and does not affect patellar height. We believe that this technique could be a promising alternative to other knee preserving surgeries in correcting varus malalignment.
Level IV, Therapeutic Study.
本研究旨在评估我们采用固定器辅助髓内钉和胫骨结节下截骨术相结合的高位胫骨截骨技术治疗内翻畸形的临床和影像学结果。
这是一项对2014年至2016年间连续32例患者（2例失访）的32个膝关节进行的回顾性研究，其中男性12例，女性18例；手术时的平均年龄为50.6±7.8（36 - 62）岁。术前和术后评估影像学和临床测量指标。统计分析采用柯尔莫哥洛夫 - 斯米尔诺夫检验、配对t检验和威尔科克森秩和检验。
平均随访期为36.1±8.15（31 - 53）个月，平均住院时间为3.6±0.1（2 - 6）天，平均凯尔格伦 - 劳伦斯评分为2.4±0.6（2 - 4）。骨愈合时间平均为16.17（12 - 29）周。与术前机械性胫骨近端内侧角、股胫角和机械轴偏移测量值相比，所有术后值均有显著变化（p<0.01）。然而，术前和术后胫骨斜率之间无统计学差异（p>0.05），术后卡顿 - 德尚指数也未显示有意义的变化（p>0.05）。术后视觉模拟量表、膝关节协会评分和改良的特种外科医院膝关节评分系统测量值与术前值相比有显著改善（p<0.01）。术后步行距离从359.4±306.2米增加到1137.50±845.1米（p<0.01）。
这种经皮技术微创，可在两个平面矫正对线，且不影响髌腱高度。我们认为，在矫正内翻畸形方面，该技术可能是其他保膝手术的一种有前景的替代方法。
IV级，治疗性研究。
