Retro-Tubercle 双平面开口楔形胫骨高位截骨术有利于髌股关节，但不利于截骨后的结节本身，而与 supra-tubercle 截骨术相比。
Retro-Tubercle Biplanar Opening Wedge High Tibial Osteotomy Is Favorable for the Patellofemoral Joint But Not for the Osteotomized Tubercle Itself Compared With Supra-Tubercle Osteotomy.
机构信息
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
出版信息
Arthroscopy. 2021 Aug;37(8):2567-2578. doi: 10.1016/j.arthro.2021.03.009. Epub 2021 Mar 18.
PURPOSE
To identify whether retro-tubercle opening-wedge high tibial osteotomy (RT-OWHTO) produces more favorable radiographic outcomes on patellofemoral joint alignment and clinical outcomes than supra-tubercle opening-wedge high tibial osteotomy (ST-OWHTO).
METHODS
From January 2017 to July 2018, patients who underwent biplanar OWHTO were allocated to 1 of 2 groups (ST-OWHTO and RT-OWHTO). Plain radiographs and computed tomography were used to analyze patellofemoral alignment and other radiologic parameters representing osteotomy configurations. Clinical outcomes were assessed using American Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index.
RESULTS
In total, 50 knees that underwent ST-OWHTO and 44 knees that underwent RT-OWHTO were enrolled. Patellar height was significantly decreased only after ST-OWHTO (Caton-Deschamps ratio: P = .007; Blackburne-Peel ratio: P = .012). Patellar tilt angle was decreased in both groups (P = .009 and .004, respectively). Postoperative posterior tibial slope (PTS) (P = .013), PTS (Δ) (P < .001), retro-tuberosity gap distance (P = .001), and retro-tuberosity tip distance (P = .001) were significantly larger in RT-OWHTO. Retro-tuberosity tip distance was significantly correlated with retro-tuberosity gap distance (P = .002), thickness of second plane osteotomy fragment (P = .027), and anterior osteotomy ratio (P = .031) in ST-OWHTO. In RT-OWHTO, it was significantly correlated with PTS (△) (P < .001), retro-tuberosity gap distance (P < .001), and sagittal angle of bi-planar osteotomy (P = .005). There were 2 cases of tibial tuberosity fracture, 9 cases of delayed union on second plane osteotomy and 5 cases of tuberosity protrusion in RT-OWHTO.
CONCLUSIONS
Although the RT-OWHTO technique maintains patellofemoral joint alignment, no difference in clinical outcome was detected. The RT-OWHTO has increased risk of tuberosity fracture, delayed union, and prominent tibial tuberosity. The surgeon should consider these negative aspects of the technique and consider adjusting additional stabilization.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
目的
比较 Retro-tubercle 开口楔形胫骨高位截骨术（RT-OWHTO）与 Supra-tubercle 开口楔形胫骨高位截骨术（ST-OWHTO）在髌股关节对线和临床结果方面的影像学结果，以确定哪种术式更优。
方法
2017 年 1 月至 2018 年 7 月，接受双平面 OWHTO 的患者被分配到 2 组中的 1 组（ST-OWHTO 和 RT-OWHTO）。使用 X 线和平扫 CT 分析髌股关节对线和代表截骨术形态的其他影像学参数。采用美国膝关节协会评分（American Knee Society Score）和西部安大略省和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index）评估临床结果。
结果
共纳入 50 例接受 ST-OWHTO 和 44 例接受 RT-OWHTO 的膝关节。仅在 ST-OWHTO 后髌骨高度显著降低（Caton-Deschamps 比：P =.007；Blackburne-Peel 比：P =.012）。两组的髌骨倾斜角均减小（P =.009 和 P =.004）。术后胫骨后倾角（PTS）（P =.013）、PTS（Δ）（P <.001）、Retro-tuberosity 间隙距离（P =.001）和 Retro-tuberosity 尖端距离（P =.001）在 RT-OWHTO 中均显著增大。在 ST-OWHTO 中，Retro-tuberosity 尖端距离与 Retro-tuberosity 间隙距离（P =.002）、第二平面截骨片厚度（P =.027）和前侧截骨比（P =.031）显著相关。在 RT-OWHTO 中，Retro-tuberosity 尖端距离与 PTS（△）（P <.001）、Retro-tuberosity 间隙距离（P <.001）和双平面截骨矢状角（P =.005）显著相关。在 RT-OWHTO 中，有 2 例胫骨结节骨折，9 例第二平面截骨延迟愈合，5 例胫骨结节突出。
结论
虽然 RT-OWHTO 技术能维持髌股关节对线，但在临床结果方面无差异。RT-OWHTO 有增加胫骨结节骨折、延迟愈合和胫骨结节突出的风险。术者应考虑到该技术的这些负面方面，并考虑调整额外的固定。
证据水平
III 级，回顾性队列研究。
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