Department of Orthopaedics, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, China.
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Orthop Surg. 2022 Dec;14(12):3441-3447. doi: 10.1111/os.13520. Epub 2022 Oct 11.
Kashin-Beck disease (KBD) is an endemic, chronic osteoarthropathy that seriously affects joint function and can lead to severe knee deformity. Osteotomy is considered to be one of the effective methods for the treatment of this disease. Therefore, we designed a novel type of osteotomy named combined proximal tibial osteotomy (CPTO), which combines the characteristics of opening-wedge high tibial osteotomy and tibial condylar valgus osteotomy.
We report the case of a 48-year-old male with knee pain and varus deformity who was diagnosed with KBD and varus knee osteoarthritis (Kellgren-Lawrence stage IV). Considering the patient's relatively young age, a varus deformity of the right knee of 16.79°, and an intra-articular instability, we performed a CPTO treatment. In this procedure, we performed an L-shaped osteotomy from the medial edge of the proximal tibia to the intercondylar eminence and an osteotomy from the medial side of the proximal tibia to the lateral side through the same incision, to adjust the leg alignment and the congruity of the joint by valgus correction. At 29 months follow-up, this patient achieved satisfactory results, with a varus right knee of 2.87°. There was significant improvement in his right knee function, pain, and joint stability.
CPTO may be an acceptable treatment for KBD patients with severe knee varus deformity and intra-articular instability. It can be considered as an alternative treatment, especially for patients with advanced osteoarthritis needing knee preservation.
大骨节病（KBD）是一种地方性、慢性骨关节病，严重影响关节功能，可导致严重的膝关节畸形。截骨术被认为是治疗这种疾病的有效方法之一。因此，我们设计了一种新型截骨术，命名为联合胫骨近端截骨术（CPTO），它结合了楔形胫骨高位截骨术和胫骨髁间外侧骨突截骨术的特点。
我们报告了一例 48 岁男性膝关节疼痛和内翻畸形病例，该患者被诊断为 KBD 和内翻膝骨关节炎（Kellgren-Lawrence Ⅳ期）。考虑到患者年龄相对较轻，右膝内翻畸形为 16.79°，且存在关节内不稳定，我们采用 CPTO 治疗。在该手术中，我们从胫骨近端内侧缘到髁间嵴行 L 形截骨，通过同一切口从胫骨近端内侧向外侧行截骨，通过外翻矫正调整下肢对线和关节吻合度。29 个月随访时，该患者取得了满意的结果，右膝内翻为 2.87°。右膝关节功能、疼痛和关节稳定性显著改善。
CPTO 可能是治疗严重膝内翻畸形和关节内不稳定的 KBD 患者的一种可接受的治疗方法。它可以作为一种替代治疗方法，特别是对于需要保留膝关节的晚期骨关节炎患者。
