Kuwashima Umito, Nejima Shuntaro, Maiotti Marco, Ahrend Marc-Daniel, Schröter Steffen
Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
Orthop J Sports Med. 2024 Jun 3;12(6):23259671241252167. doi: 10.1177/23259671241252167. eCollection 2024 Jun.
Data are limited regarding the surgical technique or outcomes of double-level osteotomy (DLO) combining medial closing-wedge distal femoral osteotomy and medial closing-wedge high tibial osteotomy in patients with moderate-to-severe valgus deformity.
PURPOSE/HYPOTHESIS: To describe the surgical technique and assess the short-term outcomes and surgical accuracy of DLO in patients with a moderate or severe valgus deformity. It was hypothesized that this technique would result in good clinical outcomes with precise deformity correction.
Case series; Level of evidence, 4.
Eight patients (mean age, 44.2 ± 10.9 years) with a moderate or severe valgus knee treated with DLO (9 knees; mechanical tibiofemoral angle [mTFA], 10.3°± 3.5°) were included. The mean follow-up was 25.1 ± 11.1 months. Preoperative to postoperative changes in radiographic parameters (mTFA, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, joint line convergence angle) and clinical scores (Hospital for Special Surgery score, Oxford Knee Score, Lysholm score) were assessed. Surgical accuracy was calculated by subtracting the achieved postoperative correction from the preoperatively planned targeted correction.
The mTFA changed significantly from 10.3°± 3.5° preoperatively to -1.8°± 3.4° postoperatively ( < .001); the mechanical lateral distal femoral angle and mechanical medial proximal tibial angle changed significantly by 5.1°± 2.7° and 5.9°± 2.2°, respectively ( < .001 for both); and the posterior distal femoral angle decreased significantly from 85.9°± 3.1° to 84.2°± 2.4° ( < .01). There was no significant difference between pre- and postoperative joint line convergence angles (3.3°± 2.3° to 2.6°± 2.1°). The accuracy of the correction was high: the mTFA achieved postoperatively differed from the mTFA planned preoperatively by a mean of 2.7°± 1.9° (range, 0.6°-6.6°). Significant pre- to postoperative improvement was seen for all outcome scores (Hospital for Special Surgery, from 67 ± 11 to 93 ± 4; Oxford Knee Score, from 29 ± 7 to 43 ± 3; Lysholm, from 41 ± 24 to 89 ± 8; < .001 for all).
High surgical accuracy was achieved, and patients who underwent varus DLO for valgus knees showed improved knee function at short-term follow-up. Varus DLO can be a surgical option to restore the optimal alignment and joint line obliquity in patients with moderate or severe valgus malalignment.
关于在中重度外翻畸形患者中联合应用股骨远端内侧闭合楔形截骨术和胫骨近端内侧闭合楔形截骨术的双平面截骨术（DLO）的手术技术或结果，数据有限。
目的/假设：描述手术技术，并评估DLO在中重度外翻畸形患者中的短期结果和手术准确性。假设该技术将通过精确的畸形矫正带来良好的临床结果。
病例系列；证据等级，4级。
纳入8例（平均年龄44.2±10.9岁）接受DLO治疗的中重度膝外翻患者（9膝；机械性胫股角[mTFA]，10.3°±3.5°）。平均随访时间为25.1±11.1个月。评估术前至术后影像学参数（mTFA、股骨远端外侧机械角、胫骨近端内侧机械角、关节线汇聚角）和临床评分（特种外科医院评分、牛津膝关节评分、Lysholm评分）的变化。手术准确性通过术前计划的目标矫正值减去术后实际达到的矫正值来计算。
mTFA从术前的10.3°±3.5°显著变化为术后的-1.8°±3.4°（P<0.001）；股骨远端外侧机械角和胫骨近端内侧机械角分别显著变化5.1°±2.7°和5.9°±2.2°（两者P<0.001）；股骨远端后角从85.9°±3.1°显著降至84.2°±2.4°（P<0.01）。术前和术后关节线汇聚角无显著差异（3.3°±2.3°至2.6°±2.1°）。矫正的准确性很高：术后达到的mTFA与术前计划的mTFA平均相差2.7°±1.9°（范围，0.6°-6.6°）。所有结果评分在术前至术后均有显著改善（特种外科医院评分，从67±11提高到93±4；牛津膝关节评分，从29±7提高到43±3；Lysholm评分，从41±24提高到89±8；所有P<0.001）。
实现了较高的手术准确性，接受膝外翻DLO手术的患者在短期随访中膝关节功能得到改善。内翻DLO可以作为一种手术选择，用于恢复中重度外翻畸形患者的最佳对线和关节线倾斜度。
