Akaoka Yusuke, Iseki Tomoya, Kanto Ryo, Onishi Shintaro, Tachibana Toshiya, Tensho Keiji, Yoshiya Shinichi, Nakayama Hiroshi
Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Jul 17;22:20-26. doi: 10.1016/j.asmart.2020.05.003. eCollection 2020 Oct.
To evaluate the effect of double level osteotomy (DLO), a combination of a lateral closed distal femoral osteotomy (LCWDFO) and medial opening wedge high tibial osteotomy (MOWHTO), on patellar height and patellofemoral alignment as compared to those of isolated MOWHTO.
Twenty-six consecutive knees in 26 patients who underwent DLO (DLO group) constituted the study population. For comparative purpose, a control cohort (N: 26) matched for age, sex, and body mass index with the study group were selected from the patients who underwent isolated MOWHTO with an opening gap of more than 10 mm during the same period (MOWHTO group). Patellar height and patellofemoral alignment were assessed on radiographs preoperatively and at 2 years after surgery. For the patellar height, following parameters were measured on a lateral radiograph: Modified Insall-Salvati Index (mISI), modified Caton-Deschamps Index (mCDI), and modified Blackburne-Peel Index (mBPI). In the assessment of patellofemoral alignment, lateral patellar tilt (LPT) and lateral patellar shift (LPS) were measured on a skyline view. The measured values were statistically compared using the Student's t-test.
In the DLO group, the patellar height measured by mCDI and mPBPI significantly decreased after surgery. As regards the patellofemoral alignment, LPT significantly decreased with no significant postoperative change detected for LPS. When the amounts of postoperative changes in radiological indices were compared between the DLO and isolated MOWHTO groups, no significant differences were detected for all parameters.
DLO induced reduction in patellar height and decreased lateral patellar tilt. Those changes in patellar position and orientation were similarly observed in isolated MOWHTO knees. Although DLO is specifically indicated for knees with severe varus deformity, the two surgical options for correction of varus knee deformity exerted similar influences on patellofemoral biomechanics.
评估双平面截骨术（DLO），即外侧闭合式股骨远端截骨术（LCWDFO）与内侧开放楔形高位胫骨截骨术（MOWHTO）相结合，与单纯MOWHTO相比，对髌骨高度和髌股关节对线的影响。
26例接受DLO手术的患者的26个连续膝关节（DLO组）构成研究人群。为了进行比较，从同期接受单纯MOWHTO且开口间隙大于10 mm的患者中选择了一个年龄、性别和体重指数与研究组相匹配的对照组（N = 26）（MOWHTO组）。术前和术后2年通过X线片评估髌骨高度和髌股关节对线。对于髌骨高度，在侧位X线片上测量以下参数：改良Insall-Salvati指数（mISI）、改良Caton-Deschamps指数（mCDI）和改良Blackburne-Peel指数（mBPI）。在评估髌股关节对线时，在髌股关节轴位片上测量外侧髌骨倾斜度（LPT）和外侧髌骨移位（LPS）。使用学生t检验对测量值进行统计学比较。
在DLO组中，mCDI和mPBPI测量的髌骨高度在术后显著降低。关于髌股关节对线，LPT显著降低，LPS术后无显著变化。当比较DLO组和单纯MOWHTO组之间放射学指标的术后变化量时，所有参数均未检测到显著差异。
DLO导致髌骨高度降低和外侧髌骨倾斜度减小。在单纯MOWHTO的膝关节中也观察到了髌骨位置和方向的类似变化。尽管DLO专门用于治疗严重内翻畸形的膝关节，但两种矫正内翻膝关节畸形的手术选择对髌股关节生物力学的影响相似。
