Deng X T, Liu J C, Li Z, Zhang Y Z
Nankai University School of Medicine, Tianjin 300071, China.
Department of Bone and Joint, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
Zhonghua Wai Ke Za Zhi. 2020 Mar 1;58(3):203-208. doi: 10.3760/cma.j.issn.0529-5815.2020.03.007.
To explore the short-term effectiveness of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint. A retrospective study was performed on 17 patients with anterior cruciate ligament injury combined with varus deformity of knee joint who underwent arthroscopic combined with dual-plane high tibial osteotomy at Department of Bone and Joint, the Affiliated Hospital of Southwest Medical University from January 2017 to June 2018.There were 11 males (11 knees) and 6 females (6 knees), aged 41.3 years (range: 32 to 49 years) .During the surgery, the weight bearing line of lower extremity was set to 62.5% position of the tibial plateau on coronal plane. The tibial slope was adjusted to the normal range on sagittal plane, and anterior cruciate ligament was reconstructed to improve the stability of knee joint.At final follow up, full length weight bearing X ray was used to evaluate the position of weight bearing line, femoral tibial angle and tibial slope pre- and post-operatively.The Lysholm scores, Hospital for Special Surgery score, Tegner knee activity scores and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test, KT-1000 side-to-side difference and pivot-shift test were used to estimate the knee joint stability. The patients were followed up for 1.8 years(range:1.2 to 2.5 years). No complication such as infection, deep vein thrombosis, graft failure, nonunion or delayed union was observed.The weight bearing line was corrected from (28.48±2.24)% preoperatively to (57.43±1.02)% postoperatively (46.80, 0.00) .The femoral tibial angle was improved from (172.31±3.37) ° preoperatively to (178.91±1.34) ° postoperatively(10.46, 0.00). The tibial slope was decreased from (14.29±1.26) ° preoperatively to (9.31±0.79) ° postoperatively (24.59, 0.00) . The KT-1000 side-to-side difference decreased from (7.95±1.19) mm preoperatively to (1.79±0.49)mm postoperatively(18.34, 0.00). At the last follow-up, Lysholm score, Hospital for Special Surgery score, Tegner score, and the IKDC knee evaluation score of patients showed significant improvement from preoperative(0.05). Arthroscopic combined with dual-plane high tibial osteotomy can get a good short term efficacy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint which can significantly improve the alignment of lower extremity and knee joint stability.
探讨关节镜联合双平面高位胫骨截骨术治疗前交叉韧带损伤合并膝关节内翻畸形的短期疗效。对2017年1月至2018年6月在西南医科大学附属医院骨与关节科行关节镜联合双平面高位胫骨截骨术的17例前交叉韧带损伤合并膝关节内翻畸形患者进行回顾性研究。其中男性11例（11膝），女性6例（6膝），年龄41.3岁（范围：32至49岁）。手术中，将下肢负重线设定在冠状面上胫骨平台的62.5%位置。在矢状面上将胫骨坡度调整至正常范围，并重建前交叉韧带以提高膝关节稳定性。末次随访时，采用全长负重X线评估术前和术后负重线位置、股胫角和胫骨坡度。采用Lysholm评分、特种外科医院评分、Tegner膝关节活动评分和国际膝关节文献委员会（IKDC）评分评估膝关节功能，同时采用Lachman试验、KT-1000两侧差值和轴移试验评估膝关节稳定性。患者随访1.8年（范围：1.2至2.5年）。未观察到感染、深静脉血栓形成、移植物失败、骨不连或延迟愈合等并发症。负重线从术前的（28.48±2.24）%矫正至术后的（57.43±1.02）%（P<0.001）。股胫角从术前的（172.31±3.37）°改善至术后的（178.91±1.34）°（P<0.001）。胫骨坡度从术前的（14.29±1.26）°降至术后的（9.31±0.79）°（P<0.001）。KT-1000两侧差值从术前的（7.95±1.19）mm降至术后的（1.79±0.49）mm（P<0.001）。在末次随访时，患者的Lysholm评分、特种外科医院评分、Tegner评分和IKDC膝关节评估评分较术前均有显著改善（P<0.05）。关节镜联合双平面高位胫骨截骨术治疗前交叉韧带损伤合并膝关节内翻畸形可获得良好的短期疗效，能显著改善下肢力线和膝关节稳定性。
