与开放性楔形高位胫骨截骨术相比，双平面截骨术能否预防髌股关节炎的进展？
Can double-level osteotomy prevent patellofemoral osteoarthritis progression compared with open wedge high tibial osteotomy?
作者信息
Akamatsu Yasushi, Kobayashi Hideo, Nejima Shuntaro, Schröter Steffen
机构信息
Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, Japan.
Department of Orthopaedic Surgery, Yokohama City University Hospital, 43-1 Kamadaicho, Hodogaya-ku, Yokohama, Japan.
出版信息
Arch Orthop Trauma Surg. 2023 Apr;143(4):2073-2085. doi: 10.1007/s00402-022-04523-0. Epub 2022 Jul 9.
PURPOSE
To compare radiographic, clinical, and arthroscopic findings in patellofemoral (PF) osteoarthritis (OA) between open wedge high tibial osteotomy (OWHTO) and double-level osteotomy (DLO) with the same operative indication.
METHODS
After adjustment for patient age, and coronal alignment, 36 knees with OWHTO alone and 36 knees with DLO were compared. Radiographic, clinical, and arthroscopic findings were documented before osteotomy. Arthroscopic findings were observed 1 year after osteotomy, and clinical and radiographic findings were observed 2 years after osteotomy. Patellar height was evaluated using the Insall-Salvati (IS) ratio, Carton-Deschamps (CD) index, and Blackburne-Peel (BP) index. Lateral patellar tilt and patellar shift were measured. A power analysis was performed.
RESULTS
The postoperative CD and BP indices in the OWHTO group were lower than those in the DLO group (p < 0.001 and p = 0.001, respectively). The CD and BP indices in both groups significantly decreased postoperatively (all p < 0.001). Tilting angles in the OWHTO and DLO groups significantly decreased postoperatively (p < 0.001 and p = 0.002, respectively). There were no significant differences in American Knee Society scores, Kujala score, and the Knee Injury and Osteoarthritis Outcome Scores between both groups. The PF OA progression of the trochlear in the OWHTO group was higher than that in the DLO group (p = 0.002), and the PF OA progression of the patellar facet in the DLO group and anterior femoral condyle in both groups on the lateral side were higher than those on the medial side (p = 0.006, 0.032, and 0.041, respectively).
CONCLUSIONS
DLO decreased the rate of low patellar height compared with OWHTO. DLO decreased the rate of PF OA progression in the trochlea compared with OWHTO. There were no significant differences in clinical outcomes in both groups.
LEVEL OF EVIDENCE
Level III, case-control study.
目的
比较具有相同手术指征的开放性楔形高位胫骨截骨术（OWHTO）和双平面截骨术（DLO）治疗髌股关节（PF）骨关节炎（OA）的影像学、临床及关节镜检查结果。
方法
在对患者年龄和冠状位对线进行调整后，比较36例单纯接受OWHTO的膝关节和36例接受DLO的膝关节。在截骨术前记录影像学、临床及关节镜检查结果。在截骨术后1年观察关节镜检查结果，在截骨术后2年观察临床及影像学检查结果。使用Insall-Salvati（IS）比值、Carton-Deschamps（CD）指数和Blackburne-Peel（BP）指数评估髌骨高度。测量髌骨外侧倾斜度和髌骨移位情况。进行了功效分析。
结果
OWHTO组术后的CD和BP指数低于DLO组（分别为p < 0.001和p = 0.001）。两组的CD和BP指数术后均显著降低（均p < 0.001）。OWHTO组和DLO组的倾斜角度术后均显著降低（分别为p < 0.001和p = 0.002）。两组之间美国膝关节协会评分、Kujala评分以及膝关节损伤和骨关节炎疗效评分无显著差异。OWHTO组滑车的PF OA进展高于DLO组（p = 0.002），DLO组髌骨小面以及两组外侧股骨髁的PF OA进展高于内侧（分别为p = 0.006、0.032和0.041）。
结论
与OWHTO相比，DLO降低了低髌骨高度的发生率。与OWHTO相比，DLO降低了滑车中PF OA的进展率。两组的临床结局无显著差异。
证据级别
III级，病例对照研究。
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