Whiteside L A
Biomechanical Research Laboratory, Missouri Bone and Joint Center, St Louis 63141, USA.
Clin Orthop Relat Res. 1995 Dec(321):32-5.
Exposure with an extended tibial tubercle and tibial crest osteotomy was done for 136 total knee arthroplasties from 1986 to 1994: There were 26 primary arthroplasties, 76 revision, 10 repeated revision, 19 infected, and 5 repeated revision for infection. Adequate exposure was achieved and further release of the quadriceps mechanism was not necessary. Two or 3 wires were passed through the lateral edge of the tibial tubercle and through the medial tibial cortex to reattach the bone fragment and patellar tendon. Mean range of motion in these cases at 2 years after surgery was 93.7 degrees (range, 15 degrees-140 degrees). Two knees had extension lag, unchanged from their preoperative condition. Two tibial tubercles had partial proximal avulsion fracture, but did not separate widely. No evidence of non-union occurred in the simple cases or in the infected cases in which repeat elevation of the tibial tubercle flap and quadriceps mechanism was done. Three wires were removed because of pain. Two tibial fractures occurred in a single patient with diabetic Charcot arthropathy, and in 1 with manipulation after open adhesiolysis. Quadriceps function was not compromised in any case. Knees with Charcot arthropathy may need prolonged protection from weightbearing. Special caution should be exercised when manipulation is done to improve knee flexibility.
1986年至1994年，对136例全膝关节置换术患者进行了胫骨结节延长和胫骨嵴截骨术：其中初次置换26例，翻修76例，再次翻修10例，感染19例，因感染再次翻修5例。实现了充分暴露，无需进一步松解股四头肌机制。用2根或3根钢丝穿过胫骨结节外侧边缘并穿过胫骨内侧皮质，以重新固定骨块和髌腱。这些病例术后2年的平均活动范围为93.7度（范围为15度至140度）。2例膝关节伸直受限，与术前情况相同。2个胫骨结节出现部分近端撕脱骨折，但未广泛分离。在单纯病例或因重复掀起胫骨结节皮瓣和股四头肌机制而感染的病例中，均未出现骨不连的证据。3根钢丝因疼痛而取出。1例患有糖尿病夏科关节病的患者和1例开放粘连松解术后手法操作的患者发生了胫骨骨折。在任何情况下，股四头肌功能均未受损。患有夏科关节病的膝关节可能需要长期避免负重。在进行手法操作以改善膝关节灵活性时应格外小心。
