Orthopaedics and Traumatology Department, Hitit University Faculty of Medicine, Corum, Turkey.
Medicine (Baltimore). 2023 Sep 8;102(36):e34980. doi: 10.1097/MD.0000000000034980.
Distal tubercle biplanar open-wedge high tibial osteotomy (DT-BOWHTO) is a method frequently applied in the treatment of knee joint medial osteoarthritis. The aim of this study was to evaluate the radiological, clinical, and functional results of patients at 5 years after DT-BOWHTO surgery. The study included a total of 41 patients who underwent DT-BOWHTO, comprising 19 (46.3%) males and 22 (53.7%) females with a mean age of 55.54 ± 4.17 (45-63) years and mean follow-up of 66.76 ± 6.29 (60-81) months. Statistical comparisons were made of the preoperative and postoperative body mass index (BMI), modified Insall-Salvati index, Blackburn-Peel index, Kelgren-Lawrence classification (KLC), tibial slope angle, American Knee Society Functional Score (AKSFS), Clinical American Knee Society Score (CAKSS), visual analog scale (VAS) pain score, Tegner Functional Activity Score (TFAS), total corrected angular measurements (TCA), and the tibio-femoral varus angle. Compared to the preoperative values, no statistically significant difference was determined in the postoperative modified Insall-Salvati index, Blackburn-Peel index, and tibial slope angle values (P > .05), and a statistically significant difference was determined in the BMI, AKSFS, CAKSS, VAS, KLC, tibio-femoral varus angle, and TFAS values (P ≤ .001). When the preoperative and postoperative BMI values were compared in 3 groups of normal, overweight, and obese, there was found to be a statistically significant difference (P = .014). No significant correlation was determined between the BMI values and the VAS and KLC values (P > .05). No significant correlation was determined between the total corrected angular and the preoperative and postoperative pain, and clinical and functional knee scores (VAS, AKSFS, CAKSS, TFAS) (P > .05). DT-BOWHTO was seen to provide extremely good 5-year results in the knee clinical findings, pain severity, and functional results. As the patella height and tibial slope angle were not changed, this did not cause the development of osteoarthritis in the patellofemoral and tibiofemoral joints. Grafting and fixation of the tibial tubercle with additional screws in the application of DT-BOWHTO were not seen to make any additional contribution to the healing of the osteotomy line. There was no relationship between increased BMI, reduced pain, and increase in knee functions in patients who underwent DT-BOWHTO.
胫骨结节双平面楔形开放截骨术（DT-BOWHTO）是治疗膝关节内侧骨关节炎的常用方法。本研究旨在评估 DT-BOWHTO 术后 5 年患者的影像学、临床和功能结果。该研究共纳入 41 例接受 DT-BOWHTO 的患者，其中 19 例（46.3%）为男性，22 例（53.7%）为女性，平均年龄 55.54±4.17（45-63）岁，平均随访 66.76±6.29（60-81）个月。对术前和术后体重指数（BMI）、改良 Insall-Salvati 指数、Blackburn-Peel 指数、Kelgren-Lawrence 分级（KLC）、胫骨倾斜角、美国膝关节协会功能评分（AKSFS）、临床美国膝关节协会评分（CAKSS）、视觉模拟评分（VAS）疼痛评分、Tegner 功能活动评分（TFAS）、总校正角度测量（TCA）和胫股内翻角进行统计学比较。与术前值相比，术后改良 Insall-Salvati 指数、Blackburn-Peel 指数和胫骨倾斜角值无统计学差异（P＞0.05），BMI、AKSFS、CAKSS、VAS、KLC、胫股内翻角和 TFAS 值有统计学差异（P≤0.001）。将术前和术后 BMI 值与正常、超重和肥胖 3 组进行比较，发现有统计学差异（P=0.014）。BMI 值与 VAS 和 KLC 值之间无显著相关性（P＞0.05）。总校正角度与术前和术后疼痛以及临床和功能膝关节评分（VAS、AKSFS、CAKSS、TFAS）之间无显著相关性（P＞0.05）。DT-BOWHTO 为膝关节临床发现、疼痛严重程度和功能结果提供了极佳的 5 年结果。由于髌骨高度和胫骨倾斜角没有改变，这不会导致髌股关节和胫股关节的骨关节炎发展。在 DT-BOWHTO 应用中，胫骨结节的植骨和附加螺钉固定对截骨线的愈合没有任何额外贡献。接受 DT-BOWHTO 的患者中，BMI 增加、疼痛减轻和膝关节功能增加之间没有关系。
