Imhoff Florian B, Fucentese Sandro F, Harrer Jörg, Tischer Thomas
Orthopädie, Universitätsklinik Balgrist, Forchstrasse 340, 8008, Zürich, Schweiz.
Abteilung für Orthopädie und Unfallchirurgie, Helmut-G.-Walther-Klinikum, Lichtenfels, Deutschland.
Orthopade. 2021 May;50(5):378-386. doi: 10.1007/s00132-021-04103-x. Epub 2021 Apr 12.
A cornerstone in the treatment of osteoarthritis in young patients is the evaluation and correction of the leg axis. The combination of a joint injury (meniscus, cartilage, ligament) and an axis deviation inevitably, depending on its extent and the patient's comorbidities such as obesity, leads to progressive osteoarthritis of the knee after a few years. In addition to the precise deformity analysis for osteotomy planning, it is important to know the normal ranges of the corresponding angles and to define a target value for axis correction. Reflecting the repertoire of different osteotomy options around the knee (open vs. closed, tibial vs. femoral, medial vs. lateral), the side effects in relation to patellofemoral maltracking, ligamentary balancing and leg length should then be assessed. Especially with regard to possible (and probable) prosthetic operations at some time in the future of young patients, new bony deformities or ligamentous insufficiencies, which potentially arise from overcorrection, must be avoided.
年轻患者骨关节炎治疗的基石是评估和矫正下肢力线。关节损伤（半月板、软骨、韧带）与力线偏差相结合，不可避免地会根据其程度以及患者的合并症（如肥胖），在几年后导致膝关节进行性骨关节炎。除了为截骨术规划进行精确的畸形分析外，了解相应角度的正常范围并确定力线矫正的目标值也很重要。考虑到膝关节周围不同截骨术选项（开放与闭合、胫骨与股骨、内侧与外侧），接下来应评估与髌股关节轨迹不良、韧带平衡和腿长相关的副作用。特别是对于年轻患者未来可能（且很可能）进行的假体手术，必须避免因过度矫正而可能出现的新的骨畸形或韧带功能不全。
