Ogawa Hiroyasu, Matsumoto Kazu, Sengoku Masaya, Yoshioka Hiroki, Yamamoto Kyosuke, Shimokawa Tetsuya, Ohnishi Kazuichiro, Akiyama Haruhiko
Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan.
Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu, 501-1194, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Dec 7;23:13-17. doi: 10.1016/j.asmart.2020.11.003. eCollection 2021 Jan.
Difference in the clinical course and outcomes between simultaneous- and staged-bilateral medial opening wedge high tibial osteotomies (OWHTOs) over time was unknown. The study hypothesis was that patients who underwent simultaneous-bilateral OWHTO (SMBO) have a more rapid improvement in knee function than those who underwent staged-bilateral OWHTO (STBO) due to difference in the change of lower limb alignment between SMBO and STBO.
The records of 56 knees in 28 patients who underwent either SMBO (n = 28) or STBO (n = 28) were retrospectively analysed. The time course data of weight-bearing line percentage (%WBL), joint line convergence angle (JLCA), and Knee Society Score were compared between the two procedures.
Hospitalisation for SMBO was longer than that for STBO by 1 week. No significant difference was observed in %WBL between the two procedures. The JLCA was significantly lower with SMBO than with the first-stage surgery of STBO (P < 0.05), but it became equivalent in both groups at the last follow-up. The knee scores in both SMBO and the first-stage surgery of STBO significantly improved in approximately 1 year. The function scores in the first-stage surgery of STBO did not significantly improve until the completion of the second-stage surgery whereas those in SMBO significantly improved 1 year after surgery and become stable. The function score 1 year after surgery was significantly higher in SMBO than in the first-stage surgery of STBO (p < 0.001).
Although both SMBO and STBO achieved the desired therapeutic results, SMBO led to earlier functional improvement and decreased JLCA compared with STBO.
同期双侧与分期双侧内侧开口楔形高位胫骨截骨术（OWHTO）的临床过程和结局随时间的差异尚不清楚。研究假设是，由于同期双侧OWHTO（SMBO）与分期双侧OWHTO（STBO）下肢对线变化不同，接受SMBO的患者膝关节功能改善比接受STBO的患者更快。
回顾性分析28例接受SMBO（n = 28）或STBO（n = 28）的患者的56个膝关节记录。比较两种手术方式之间负重线百分比（%WBL）、关节线汇聚角（JLCA）和膝关节协会评分的时间进程数据。
SMBO的住院时间比STBO长1周。两种手术方式之间的%WBL未观察到显著差异。SMBO的JLCA显著低于STBO的一期手术（P < 0.05），但在最后一次随访时两组相当。SMBO和STBO一期手术的膝关节评分在大约1年内均显著改善。STBO一期手术的功能评分直到二期手术完成才显著改善，而SMBO的功能评分在术后1年显著改善并趋于稳定。术后1年SMBO的功能评分显著高于STBO一期手术（p < 0.001）。
虽然SMBO和STBO均取得了预期的治疗效果，但与STBO相比，SMBO能带来更早的功能改善并降低JLCA。
