Hernigou P
Hôpital Henri Mondor, Créteil.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(3):241-50.
The study defines the conditions in which valgus osteotomy can produce satisfactory 20-year results in cases of medial unicompartmental gonarthrosis.
Among a series of 93 osteotomies, 35 knees were followed up for 20 years. Changes to the medial and lateral femorotibial compartments were identified on forced varus and valgus radiographs and on foot standing Xray. The condition of the patellofemoral articulation was defined on patellofemoral aspect at 30 degrees flexion. Frontal axial deviation was monitored by preoperative and postoperative standing film (first year, 10 years and 20 years).
Only 25 knees still had a satisfactory functional result (no mechanical pain). However, among these 25 knees, 13 good functional results were obtained after a new osteotomy performed between the 7th and 15th year after initial surgery. There were therefore only 12 knees which managed to reach 20 years with their original tibial osteotomy. Radiologically, in absence of adverse hypercorrection (greater than 6 degrees valgus), there was no deterioration or only small deterioration of the lateral femorotibial compartment at 20 years even among the knees which had undergone two tibial osteotomies.
Osteotomy rarely avoids the problem of recurrent deformity which appears fairly rapidly (before 10 years) when initial correction is poor (below 3 degrees valgus). However, even correction of between 3 and 6 degrees valgus was not immune to recurrent varus deformity at long term (20 years): among knees with goniometry between 3 degrees and 6 degrees at the one-year postoperative review, 20 were still within this group by the 10th year; but only 9 knees were still in this range at 20 years.
Whilst longevity of a tibial osteotomy seems limited, a second valgus tibial osteotomy can reproduce the same effects as the first (no pain and preservation of the medial femorotibial compartment): 13 repeated tibial osteotomies produced a good result at 20 years follow-up which suggests that medial femorotibial gonarthroses in younger patients can be treated conservatively.
本研究确定了在单纯内侧间室膝关节骨性关节炎病例中，外翻截骨术能产生满意的20年效果的条件。
在一系列93例截骨术中，35例膝关节进行了20年的随访。通过强迫内翻和外翻X线片以及站立位足部X线片确定股骨胫内侧和外侧间室的变化。在屈膝30度时，通过髌股位片确定髌股关节的情况。通过术前和术后站立位片（第1年、第10年和第20年）监测额状面轴向偏差。
仅有25例膝关节仍有满意的功能结果（无机械性疼痛）。然而，在这25例膝关节中，13例在初次手术后第7年至第15年间进行了新的截骨术，获得了良好的功能结果。因此，仅有12例膝关节最初的胫骨截骨术维持到了20年。放射学检查显示，在没有不良过度矫正（外翻大于6度）的情况下，即使是接受了两次胫骨截骨术的膝关节，在20年时外侧股骨胫间室也没有恶化或仅有轻微恶化。
截骨术很少能避免复发畸形问题，当初始矫正不佳（外翻小于3度）时，复发畸形出现得相当快（10年之前）。然而，即使是3至6度的外翻矫正，从长期（20年）来看也不能避免复发内翻畸形：在术后1年复查时角度测量在3度至6度之间的膝关节中，到第10年仍有20例在这个范围内；但到20年时，只有9例膝关节仍在这个范围内。
虽然胫骨截骨术的持久性似乎有限，但第二次胫骨外翻截骨术可以产生与第一次相同的效果（无疼痛并保留股骨胫内侧间室）：13例重复胫骨截骨术在20年随访时效果良好，这表明年轻患者的股骨胫内侧骨性关节炎可以采用保守治疗。
