Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee
Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee
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DOI：
10.1007/s00167-020-05890-0
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发表时间：
2020-02-13
影响因子：
3.8
通讯作者：
Usellini, E.
中科院分区：
文献类型：
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作者：
Berruto, M.;Maione, A.;Usellini, E.
目的 本研究的目的是分析接受闭合楔形高位胫骨截骨术 (HTO) 治疗内侧间室骨关节炎的患者的长期临床和放射学结果，并评估膝关节置换术的转化率。方法 在我院进行了一项回顾性、非随机、单中心研究，纳入 1989 年至 2012 年间的 166 名患者。最终人群由 82 名患者（94 膝）组成，手术时中位年龄为 53 岁（范围 45-73）。所有患者均接受临床评估（HSS 评分、Tegner 量表、VAS 和 Crosby-Insall 分级）和影像学评估（骨关节炎分期、髋膝踝 (HKA) 角、胫骨坡度和干骺端内翻）。结果 平均随访时间为 11.9 +/- 7.2 年。在最后一个对照（n.s.）中，HSS 评分从 70.8 +/- 10 显着增加到 93.2 +/- 9.1（p < 0.05），而 Tegner 量表从 1.3 +/- 0（范围 1-4）增加到 2.8 +/- 0.7（范围 2-6）；最后一次随访时 VAS 评分从 7.9 +/- 1.4 显着下降至 1.6 +/- 1.1 (p < 0.05)。根据 Crosby-Insall 分级系统，80 名患者 (97.4%) 报告了良好的结果。 HKA角从6.9度+/-3.5下降到2.6度+/-2.6（p<0.01），胫骨坡度从10.1度+/-1.4下降到6.8度+/-2.1（p<0.05），最后干骺端内翻从4.2度+/-0下降到2.1度+/-1.2（n.s.）最后的后续行动。不良事件发生率为 4.8%。截骨术后 10 年存活率为 92%，15 年存活率为 82%，20 年存活率为 80%。报告了 16 次修订 (9.6%)，平均周期为 12.8 年。结论 CW-HTO 是治疗内侧骨关节炎的有效选择，在临床和放射学结果方面均取得了成功的结果。
Purpose The purpose of this study was to analyze the long-term clinical and radiological outcomes of patients who underwent closing-wedge High Tibial Osteotomy (HTO) for the treatment of medial compartment osteoarthritis and to evaluate the conversion rate to knee arthroplasty. Methods A retrospective, non-randomized, monocentric study was performed in our Institution considering 166 patients between 1989 and 2012. The final population was composed by 82 patients (94 knees), median age at time of operation was 53 (range 45-73) years. All patients were evaluated clinically (HSS Score, Tegner Scale, VAS and Crosby-Insall Grading) and radiographically (osteoarthritis staging, hip-knee-ankle (HKA) angle, tibial slope and metaphyseal varus). Results Mean follow-up was 11.9 +/- 7.2 years. HSS Score increased significantly from 70.8 +/- 10 to 93.2 +/- 9.1 (p < 0.05) instead Tegner Scale increased from 1.3 +/- 0 (range 1-4) to 2.8 +/- 0.7 (range 2-6) at the last control (n.s.); VAS score significantly decreased from 7.9 +/- 1.4 to 1.6 +/- 1.1 (p < 0.05) at last follow-up. According to the Crosby-Insall Grading System, 80 patients (97.4%) reported excellent-good results. HKA angle decreased from 6.9 degrees +/- 3.5 to 2.6 degrees +/- 2.6 (p < 0.01), tibial slope decreased from 10.1 degrees +/- 1.4 to 6.8 degrees +/- 2.1 (p < 0.05) and finally the metaphyseal varus decreased from 4.2 degrees +/- 0 to 2.1 degrees +/- 1.2 (n.s.) at the last follow-up. Adverse events were reported in 4.8%. Osteotomy survivorship rate resulted 92% at 10 years, 82% at 15 years and 80% at 20 years. Sixteen revisions (9.6%) were reported at a mean period of 12.8 years. Conclusions CW-HTO is a valid option for medial osteoarthritis treatment, with successful results in both clinical and radiological outcomes.