A case series of lateral opening wedge high tibial osteotomy for valgus malalignment
A case series of lateral opening wedge high tibial osteotomy for valgus malalignment
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DOI：
10.1007/s00167-012-2070-y
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发表时间：
2013-01-01
影响因子：
3.8
通讯作者：
Litchfield, Robert B.
中科院分区：
文献类型：
--
作者：
Collins, Brett;Getgood, Alan;Litchfield, Robert B.
外侧开放楔形胫骨高位截骨术是一种罕见的用于治疗膝外翻背景下膝关节外侧疼痛和退变的手术技术。几乎没有证据表明该手术适用于需要小矫正截骨的患者。2002年至2008年期间，对23例（24膝）患者进行了外侧开放楔形胫骨高位截骨术，至少随访2年。一种手术技术，避免了腓骨截骨术的需要。在基线、术后6个月和最终随访时评估不良事件、患者报告结局和影像学对线测量。12名患者也在相同时间点进行了3D步态分析，平均随访时间为52个月（+/- 20.4）。在下肢功能量表[平均变化（95% CI）= 10（2.4，17.6）]和膝关节损伤和骨关节炎结局评分[平均变化（95% CI）= 10.9（0.5，21.4）]中发现了统计学和临床显著性改善。机械轴从2.4 +/- A 2.4A度外翻变为0 +/- A 2.6A度内翻（p < 0.001），解剖轴从6.9 +/- A 2.8A度到4.7 +/- 2.5A度外翻（p < 0.001），负重线偏移从60.2 +/- A 11.4%变为49.5 +/- A 12.4%（p < 0.001）。胫骨外侧倾斜度从6.5 +/- A 2.2A度变化至7.5 +/- A 2.3A度，变化非常小，无统计学显著性（n.s.）。步态期间的峰值膝关节内收力矩显著增加[平均变化（95% CI）= 0.72% BW*Ht（0.42，1.02）]，表明动态膝关节负荷向内侧移动。两名患者在研究期间接受了全膝关节置换术。外侧开放楔形胫骨高位截骨术是一种可行的手术选择，用于需要轻度矫正的外侧膝关节疼痛和外翻对线不良的患者。
Lateral opening wedge high tibial osteotomy is a rarely employed surgical technique used for the treatment of lateral knee pain and degeneration in the setting of genu valgum. There exists little evidence of the suitability of this procedure for patients requiring osteotomies with a small correction.A case series of 23 patients (24 knees) undergoing lateral opening wedge high tibial osteotomy with a minimum follow-up of 2 years was performed between 2002 and 2008. A surgical technique avoiding the need for fibular osteotomy is described. Adverse events, patient-reported outcomes and radiographic measures of alignment were assessed at baseline, at 6 months postoperatively, and at time of final follow-up. A subgroup of 12 patients also underwent 3D gait analysis at the same time points.The mean follow-up was 52 months (+/- 20.4). Statistically and clinically significant improvements were identified in the lower extremity functional scale [mean change (95 %CI) = 10 (2.4, 17.6)], and in the knee injury and osteoarthritis outcome score [mean change (95 %CI) = 10.9 (0.5, 21.4)]. Mechanical axis changed from 2.4 +/- A 2.4A degrees valgus to 0 +/- A 2.6A degrees varus (p < 0.001), anatomical axis from 6.9 +/- A 2.8A degrees to 4.7 +/- 2.5A degrees valgus (p < 0.001), with weight-bearing line offset changing from 60.2 +/- A 11.4 % to 49.5 +/- A 12.4 % (p < 0.001). Change in lateral tibial slope, from 6.5 +/- A 2.2A degrees to 7.5 +/- A 2.3A degrees, was very small and not statistically significant (n.s.). The peak knee adduction moment during gait significantly increased [mean change (95 %CI) = 0.72 %BW*Ht (0.42, 1.02), suggesting a medial shift in dynamic knee joint load. Two patients underwent total knee arthroplasty during the study period.Lateral opening wedge high tibial osteotomy is a viable surgical option for patients with lateral knee pain and valgus malalignment requiring small degrees of correction.IV.