Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
Arch Orthop Trauma Surg. 2020 Dec;140(12):2077-2084. doi: 10.1007/s00402-020-03598-x. Epub 2020 Sep 18.
Excessive femoral internal torsion is an important risk factor for patellar dislocation. The aim of the present study was to estimate the effect of derotational osteotomy of the femur on the tibial tubercle trochlear groove (TTTG) distance or patellar tilt angle (PTA) and to report our clinical outcomes of recurrent patellar dislocation after femoral derotation osteotomy.
A retrospective analysis of 16 patients (17 knees) with recurrent patellar dislocation treated by femoral derotation osteotomy in our department from January 2016 to February 2019 was carried out. The procedure was performed with supracondylar femoral derotation. A few procedures were combined with soft tissue procedures. Knee function was evaluated by using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS) score and patient satisfaction. Additionally, CT was used to assess the influence of femoral derotational osteotomy on TTTG distance and PTA.
The average femoral antetorsion angle before surgery was 33° (SD ± 5°), and the intraoperative correction angle was 23° (SD ± 4°). A total of 17 femoral derotation osteotomies in 16 patients with patellar instability [11 females, 5 males, aged 20.8 (range 15-41) years] were included in the study. No dislocation occurred within 26.5 months after follow-up (range 12-49 months). The IKDC score, Kujala score, Lysholm score and VAS score significantly improved. The preoperative TTTG distance was 15.63 mm (SD ± 2.07 mm), and it was 14.69 mm (SD ± 1.78 mm) at the follow-up. The PTA decreased from 26.35° (SD ± 6.86°) to 11.65° (SD ± 2.85°). The powers of TTTG and PTA measurements are 0.78 and 1.00, respectively and all of these differences were statistically significant.
Derotational osteotomy of the femur for the treatment of recurrent patellar dislocation can achieve good clinical results, including improved TTTG distance and PTA and improved knee function.
股骨内旋过度是髌骨脱位的一个重要危险因素。本研究旨在评估股骨旋转移位截骨术对滑车沟-胫骨结节（TTTG）距离或髌骨倾斜角（PTA）的影响，并报告我们在股骨旋转移位截骨术后复发性髌骨脱位的临床结果。
对 2016 年 1 月至 2019 年 2 月我科收治的 16 例（17 膝）复发性髌骨脱位患者行股骨旋转移位截骨术的病例进行回顾性分析。术式采用髁上股骨旋转移位截骨，部分病例联合软组织手术。采用国际膝关节文献委员会（IKDC）评分、Kujala 评分、Lysholm 评分、视觉模拟评分（VAS）和患者满意度评估膝关节功能。此外，采用 CT 评估股骨旋转移位截骨术对 TTTG 距离和 PTA 的影响。
术前股骨前旋角度平均为 33°（标准差±5°），术中矫正角度为 23°（标准差±4°）。共纳入 16 例髌骨不稳定患者（11 例女性，5 例男性）行 17 例股骨旋转移位截骨术，年龄 20.8（15-41）岁。随访 26.5 个月内（12-49 个月）无脱位发生。IKDC 评分、Kujala 评分、Lysholm 评分和 VAS 评分均显著改善。术前 TTTG 距离为 15.63mm（标准差±2.07mm），随访时为 14.69mm（标准差±1.78mm）。PTA 从 26.35°（标准差±6.86°）降至 11.65°（标准差±2.85°）。TTTG 和 PTA 测量的功效分别为 0.78 和 1.00，差异均有统计学意义。
股骨旋转移位截骨术治疗复发性髌骨脱位可获得良好的临床效果，包括改善 TTTG 距离和 PTA 以及改善膝关节功能。
