Sheridan Gerard A, Page Brian J, Greenstein Michael D, Reif Taylor J, Fragomen Austin T, Rozbruch S Robert
Department of Orthopaedics, University of Galway, Galway, Ireland.
Hospital for Special Surgery, Orthopaedic Trauma Service; New York Presbyterian - Weill Cornell Medical Center, Orthopaedic Trauma Service, New York, United States of America.
Strategies Trauma Limb Reconstr. 2024 May-Aug;19(2):82-86. doi: 10.5005/jp-journals-10080-1620. Epub 2024 Aug 14.
Angular deformities of the tibia and femur lead to mechanical axis deviation (MAD) of the lower limb and malorientation of the joints adjacent to the deformity. The current study analyses the outcomes of using a medial closing wedge high tibial osteotomy (MCWHTO) for the management of genu valgum with high medial proximal tibial angle (MPTA), and combined MCWHTO with lateral opening-wedge distal femoral osteotomy (LOWDFO) in the setting of concomitant genu varum with low lateral distal femoral angle (LDFA).
There were 18 high tibial osteotomy (HTO)-only and 13 combined HTO + distal femoral osteotomy (DFO) procedures performed. The primary radiographic outcome variables included postoperative MPTA and MAD (in mm). The accuracy of MAD correction was expressed as a percentage. The postoperative posterior proximal tibial angle (PPTA) and limb length discrepancy (LLD) were also measured as secondary radiographic outcome variables. The clinical outcome variables included intraoperative surgical complications (e.g., hinge fracture), all-causes for revision, union rate, time to union, and postoperative knee range of motion. Functional outcomes used included the LDSRS, PROMIS, and EuroQOL scores.
The mean preoperative MPTA was 92.9° (SD = 1.81, range: 88-96). After surgical correction, the mean MPTA was 86.0° (SD = 1.80, range: 83-90) ( < 0.0001). The mean preoperative MAD was 32.5 mm (SD = 20.16, range: 10-77) lateral to the centre of the knee joint. The mean postoperative MAD was 2.44 mm medial to the centre of the joint (SD = 7.13, range: 13 medial - 15 lateral) ( < 0.0001). The mean change in MAD achieved through surgical correction was 38.16 mm (SD = 17.94, range: 13-77). The accuracy of MAD correction was 96.1% (SD = 0.06%, range: 81.25-100%). The time to unassisted WB was a mean of 75 days (SD = 44.5, range: 44-242).There was a single stable hinge fracture and one case of chronic regional pain syndrome diagnosed. There were no cases of non-union and no indications for revision surgery in any case.
Medial closing wedge high tibial osteotomy is an effective surgical procedure for the management of genu valgum deformity. The MPTA, LDFA, and MAD can be accurately corrected without significantly altering PPTA or limb length. It may be combined with open lateral distal femoral osteotomy for cases with femoral and tibial contributions to deformity without significantly impacting clinical outcomes. Functional outcomes, specifically relating to self-image are significantly improved after the MCWHTO has been performed.
Sheridan GA, Page BJ, Greenstein MD, Medial Closing Wedge High Tibial Osteotomy Accurately Corrects Genu Valgum without Iatrogenic Deformity or Complications: A Consecutive Series of Thirty-one Procedures. Strategies Trauma Limb Reconstr 2024;19(2):82-86.
胫骨和股骨的角形畸形会导致下肢机械轴偏移（MAD）以及畸形附近关节的方向异常。本研究分析了使用内侧闭合楔形高位胫骨截骨术（MCWHTO）治疗内侧近端胫骨角（MPTA）较高的膝外翻的效果，以及在合并外侧远端股骨角（LDFA）较低的膝内翻情况下，将MCWHTO与外侧开放楔形远端股骨截骨术（LOWDFO）联合应用的效果。
共进行了18例单纯高位胫骨截骨术（HTO）和13例HTO联合远端股骨截骨术（DFO）。主要影像学结果变量包括术后MPTA和MAD（以毫米为单位）。MAD矫正的准确性以百分比表示。术后胫骨近端后角（PPTA）和肢体长度差异（LLD）也作为次要影像学结果变量进行测量。临床结果变量包括术中手术并发症（如铰链骨折）、翻修的所有原因、愈合率、愈合时间以及术后膝关节活动范围。使用的功能结果包括LDSRS、PROMIS和EuroQOL评分。
术前平均MPTA为92.9°（标准差 = 1.81，范围：88 - 96）。手术矫正后，平均MPTA为86.0°（标准差 = 1.80，范围：83 - 90）（P < 0.0001）。术前平均MAD在膝关节中心外侧32.5毫米（标准差 = 20.16，范围：10 - 77）。术后平均MAD在关节中心内侧2.44毫米（标准差 = 7.13，范围：内侧13 - 外侧15）（P < 0.0001）。通过手术矫正实现的MAD平均变化为38.16毫米（标准差 = 17.94，范围：13 - 77）。MAD矫正的准确性为96.1%（标准差 = 0.06%，范围：81.25 - 100%）。无需辅助负重行走时间平均为75天（标准差 = 44.5，范围：44 - 242）。诊断出1例稳定的铰链骨折和1例慢性区域疼痛综合征。没有不愈合病例，且在任何情况下均无翻修手术指征。
内侧闭合楔形高位胫骨截骨术是治疗膝外翻畸形的有效手术方法。MPTA、LDFA和MAD可以准确矫正而不会显著改变PPTA或肢体长度。对于股骨和胫骨均导致畸形的病例，可将其与外侧远端股骨开放截骨术联合应用，且不会显著影响临床结果。进行MCWHTO后，与自我形象相关的功能结果有显著改善。
Sheridan GA, Page BJ, Greenstein MD, 内侧闭合楔形高位胫骨截骨术准确矫正膝外翻且无医源性畸形或并发症：连续31例手术系列。创伤肢体重建策略2024；19(2):82 - 86。
