Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey.
Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey.
Arthroscopy. 2020 Oct;36(10):2710-2717. doi: 10.1016/j.arthro.2020.06.024. Epub 2020 Jul 4.
The primary aim was to evaluate the influence of the surgical modification on posterior tibial slope (PTS) and patellar height in open-wedge high tibial osteotomy (OWHTO). The secondary aim was to evaluate the influence of preoperative mechanical axis deviations (MA) on PTS METHODS: Between January 2014 and February 2016, patients with a diagnosis of medial-compartment osteoarthritis who had undergone OWHTO with posteromedial osteotomy technique with a minimum follow-up of 3 months were included in this retrospective study. Preoperative and postoperative PTS angles with 3 different methods and patellar heights with respect to the Insall-Salvati and Caton-Deschamps indices were measured on lateral radiographs by 2 observers. Patients were grouped according to preoperative MA (either <10° or ≥10°). PTS changes were compared between groups RESULTS: Thirty consecutive knees of 28 patients were evaluated. Preoperative mean PTS angles were 9.50° ± 4.47° (posterior tibial cortex referenced), 11.51° ± 4.50° (tibial anatomical axis referenced), and 10.80° ± 4.58° (posterior fibular cortex referenced); postoperative angles were 6.10° ± 4.23°, 8.78° ± 4.57°, and 8.11° ± 4.55°, respectively. PTS was significantly decreased postoperatively with respect to all 3 methods (P < .0001). Mean preoperative and postoperative Insall-Salvati indices were 1.04 ± 0.16 and 1.07 ± 0.17, respectively (P = .088). Mean preoperative and postoperative Caton-Deschamps indices were 0.87 ± 0.18 and 0.78 ± 0.18, respectively (P = .017). PTS changes were not statistically significant between groups with respect to MA (P values .861, .723, and .727, respectively) CONCLUSIONS: It is possible to preserve and even decrease PTS with an OWHTO performed posterior to MCL in a posteromedial to anterolateral direction.
Level IV, retrospective case series.
本研究的主要目的是评估手术修正对开放式楔形胫骨高位截骨术（OWHTO）中后胫骨倾斜角（PTS）和髌骨高度的影响。次要目的是评估术前机械轴偏差（MA）对 PTS 的影响。
本回顾性研究纳入了 2014 年 1 月至 2016 年 2 月间诊断为内侧间室骨关节炎并接受 OWHTO 联合后内侧入路截骨术的患者，随访时间至少 3 个月。在侧位 X 线片上，由 2 名观察者使用 3 种不同的方法测量 PTS 角度和髌骨高度，并参考 Insall-Salvati 和 Caton-Deschamps 指数。根据术前 MA（<10°或≥10°）将患者分为两组。比较两组间 PTS 变化。
共评估了 28 名患者的 30 个膝关节。术前平均 PTS 角分别为胫骨解剖轴参考 9.50°±4.47°（胫骨后皮质参考）、11.51°±4.50°（胫骨解剖轴参考）和 10.80°±4.58°（腓骨后皮质参考）；术后分别为 6.10°±4.23°、8.78°±4.57°和 8.11°±4.55°。所有 3 种方法的 PTS 术后均显著降低（P<.0001）。术前和术后平均 Insall-Salvati 指数分别为 1.04±0.16 和 1.07±0.17（P=0.088）。术前和术后平均 Caton-Deschamps 指数分别为 0.87±0.18 和 0.78±0.18（P=0.017）。MA 方面，2 组间 PTS 变化无统计学差异（P 值分别为 0.861、0.723 和 0.727）。
在 MCL 后由后内侧到前外侧方向行 OWHTO 时，PTS 可以被保留甚至降低。
IV 级，回顾性病例系列。
