Abs Alice, Micicoi Grégoire, Khakha Raghbir, Escudier Jean-Charles, Jacquet Christophe, Ollivier Matthieu
Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France.
APHM, CNRS, ISM, Aix-Marseille University, Marseille, France.
Orthop J Sports Med. 2023 Feb 17;11(2):23259671221148458. doi: 10.1177/23259671221148458. eCollection 2023 Feb.
In bifocal varus deformity, double-level osteotomy (DLO) is advocated to treat lower limb alignment to prevent an adverse increase in joint line obliquity.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare the clinical and radiological results after DLO and open-wedge high tibial osteotomy (OWHTO) in patients with combined varus deformity. It was hypothesized that DLO would improve clinical results without increasing the complication rate compared with OWHTO.
Cohort study; Level of evidence, 3.
Inclusion criteria were medial tibiofemoral compartment pain, varus knee deformity with an abnormal medial proximal tibial angle <84° and a lateral distal femoral angle >90°, a functional anterior cruciate ligament, failure of nonoperative treatment, and a minimum 2-year follow-up with all clinical and radiological data. The rate of return to work or sports; the Knee injury and Osteoarthritis Outcome Score (KOOS); the University of California, Los Angeles (UCLA) activity score; and patient satisfaction were assessed at a minimum of 2 years of follow-up. Statistical comparison of the 2 groups was made using the chi-square or Student test.
A total of 69 consecutive patients were analyzed, of whom 38 underwent OWHTO and 31 underwent DLO surgery. A significant between-group difference was found for all radiological parameters; in particular, there was less joint line obliquity after DLO compared with OWHTO (1.7° vs 5.6°; < .001). DLO provided better outcomes compared with OWHTO regarding the UCLA score (4.3 vs 6.7; < .001) and patient satisfaction (2.6 vs 3.9; < .001), but no significant difference in KOOS or return to work or sports was observed. The OWHTO group had more hinge fractures than the DLO group (34.2% vs 12.9%; < .001).
For combined tibial and femoral varus deformity, DLO produced more physiologic joint line obliquity with slightly improved UCLA and patient satisfaction scores. A greater incidence of hinge fracture was observed after isolated OWHTO compared with DLO due to a larger tibial correction; however, this had little effect on clinical results at the 2-year follow-up.
在双平面内翻畸形中，提倡采用双平面截骨术（DLO）来治疗下肢对线，以防止关节线倾斜度出现不利增加。
目的/假设：本研究的目的是比较双平面截骨术（DLO）和开放性楔形高位胫骨截骨术（OWHTO）治疗合并内翻畸形患者后的临床和影像学结果。假设与OWHTO相比，DLO在不增加并发症发生率的情况下能改善临床结果。
队列研究；证据等级，3级。
纳入标准为胫股内侧间室疼痛、内翻膝畸形且胫骨近端内侧角异常<84°以及股骨远端外侧角>90°、前交叉韧带功能正常、非手术治疗失败，以及至少2年的随访且具备所有临床和影像学数据。在至少2年的随访时评估重返工作或运动的比率、膝关节损伤和骨关节炎疗效评分（KOOS）、加利福尼亚大学洛杉矶分校（UCLA）活动评分以及患者满意度。使用卡方检验或Student检验对两组进行统计学比较。
共分析了69例连续患者，其中38例行OWHTO，31例行DLO手术。在所有影像学参数上发现两组之间存在显著差异；特别是，与OWHTO相比，DLO术后关节线倾斜度更小（1.7°对5.6°；P <.001）。在UCLA评分（4.3对6.7；P <.001）和患者满意度（2.6对3.9；P <.001）方面，DLO与OWHTO相比结果更好，但在KOOS或重返工作或运动方面未观察到显著差异。OWHTO组的铰链骨折比DLO组更多（34.2%对12.9%；P <.001）。
对于合并胫骨和股骨内翻畸形，DLO产生的关节线倾斜度更符合生理，UCLA评分和患者满意度略有改善。与DLO相比，单纯OWHTO后由于胫骨矫正幅度更大，铰链骨折的发生率更高；然而，在2年随访时这对临床结果影响不大。
