重度内翻性骨关节炎双平面截骨术后的中期生存率和关节生理角度

Mid-term survival and physiological joint angles after double level osteotomy of severe varus osteoarthritis.

作者信息

Herbst Moritz, Schröter Steffen, Ateschrang Atesch, Ihle Christoph, Finger Felix, Histing Tina, Döbele Stefan, Fischer Cornelius, Ahrend Marc-Daniel

机构信息

Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.

Department of Traumatology and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2025 Jul 13. doi: 10.1002/ksa.12754.

DOI:10.1002/ksa.12754

PMID:40652372

Abstract

PURPOSE

Double-level osteotomy (DLO) is a joint-preserving technique for the treatment of symptomatic varus knee osteoarthritis (OA) in cases of femoral and tibial combined deformity. The study aimed to investigate the mid-term survival rate (>5 years) and restoration of postoperative joint angles.

METHODS

Sixty-five knees underwent DLO (medial open wedge high tibial osteotomy (MOWHT) and lateral closing wedge distal femoral osteotomy (LCWDFO) between 2011 and 2015. Minimum follow-up was 5 years. The survival rate was recorded and, in case of conversion to knee arthroplasty, the time of conversion. Radiographs were obtained preoperatively, 6 weeks postoperatively and at the last follow-up. On radiographs mechanical tibiofemoral angle (mTFA), mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal femur angle (mLDFA), joint line convergence angle (JLCA) and joint line obliquity (JLO) were measured. The clinical outcome was measured using International Knee Documentation Committee (IKDC), Oxford and Lysholm score.

RESULTS

Forty-nine knees (75% follow-up) were included after 8.0 ± 1.4 years. At the last follow-up, six knees underwent arthroplasty (7-year survival rate: 91.8%; 5-year survival rate: 93.9%) in average after 5.1 ± 2.3 years. Preoperatively, there was a varus deformity of -10.0 ± 2.5° (mTFA). In addition, pathologic knee joint angles with an mMPTA of 84.7 ± 2.2°, an mLDFA of 91.4 ± 2.1°, an JLCA of 3.4 ± 1.8 and a JLO of 3.0 ± 1.9°. Six weeks postoperatively mTFA was 0.7 ± 2.2° with values of mMPTA 91.0 ± 2.3°, mLDFA 86.8 ± 2.0° and JLO of 2.8 ± 2.1°. In the mid-term, a preserved leg axis (mTFA: -0.9 ± 2.7°) and preserved joint angles (mMPTA: 90.3 ± 2.7°, mLDFA: 87.1 ± 2.3°, JLCA: 4.3 ± 1.9 JLO: 3.2 ± 2.1°) were observed. At the last follow-up, the IKDC, Oxford Knee Score (OKS) and Lysholm score were: 61.2%, 36.1 points and 78.3 points, respectively.

CONCLUSION

The study demonstrates that DLO is an effective surgical technique to restore physiological joint angles in patients with severe preoperative deformity and symptomatic varus OA. Mid-term results indicate good clinical outcomes and a low conversion rate to TKA.

LEVEL OF EVIDENCE

Level IV.

摘要

目的

双平面截骨术（DLO）是一种保留关节的技术，用于治疗股骨和胫骨联合畸形的症状性膝内翻骨关节炎（OA）。本研究旨在调查中期生存率（>5年）以及术后关节角度的恢复情况。

方法

2011年至2015年间，65例膝关节接受了双平面截骨术（内侧开放楔形高位胫骨截骨术（MOWHT）和外侧闭合楔形股骨远端截骨术（LCWDFO））。最短随访时间为5年。记录生存率，若转为膝关节置换术，则记录转换时间。术前、术后6周及最后一次随访时均拍摄X线片。在X线片上测量机械性胫股角（mTFA）、机械性胫骨近端内侧角（mMPTA）、机械性股骨远端外侧角（mLDFA）、关节线汇聚角（JLCA）和关节线倾斜度（JLO）。使用国际膝关节文献委员会（IKDC）、牛津和Lysholm评分来评估临床结果。

结果

8.0±1.4年后，纳入49例膝关节（随访率75%）。在最后一次随访时，平均5.1±2.3年后，有6例膝关节接受了关节置换术（7年生存率：91.8%；5年生存率：93.9%）。术前，存在-10.0±2.5°的内翻畸形（mTFA）。此外，病理膝关节角度为mMPTA 84.7±2.2°、mLDFA 91.4±2.1°、JLCA为3.4±1.8°和JLO为3.0±1.9°。术后6周，mTFA为0.7±2.2°；mMPTA值为91.0±2.3°，mLDFA为86.8±2.0°，JLO为2.8±2.1°。在中期，观察到下肢力线保留（mTFA：-0.9±2.7°）和关节角度保留（mMPTA：90.3±2.7°，mLDFA：87.1±2.3°，JLCA：4.3±1.9°，JLO：3.2±2.1°）。在最后一次随访时，IKDC、牛津膝关节评分（OKS）和Lysholm评分分别为：61.2%、36.1分和78.3分。