Open-Wedge Osteotomy Using an Internal Plate Fixator in Patients With Medial-Compartment Gonarthritis and Varus Malalignment: 3-Year Results With Regard to Preoperative Arthroscopic and Radiographic Findings
Open-Wedge Osteotomy Using an Internal Plate Fixator in Patients With Medial-Compartment Gonarthritis and Varus Malalignment: 3-Year Results With Regard to Preoperative Arthroscopic and Radiographic Findings
复制标题
DOI：
10.1016/j.arthro.2010.05.006
复制
发表时间：
2010-12-01
影响因子：
4.7
通讯作者：
Koestler, Wolfgang
中科院分区：
文献类型：
--
作者：
Niemeyer, Philipp;Schmal, Hagen;Koestler, Wolfgang
目的：我们的目的是评价使用内固定板（TomoFix; Synthes，索洛图恩，瑞士）进行开放楔形胫骨高位截骨术（HTO）的膝关节内侧间室骨关节炎和内翻对线不良患者的3年临床结果。临床结果与手术时的关节镜和影像学检查结果相关。研究方法：本研究纳入了69例接受开放楔形HTO治疗膝关节内侧间室骨关节炎的患者，至少随访36个月。在术前和HTO后6、12、24和36个月，使用主观国际膝关节文献委员会和Lysholm评分评估膝关节功能。HTO前的关节镜检查结果和胫骨近端干骺端畸形（胫骨内翻角）的影像学评估与临床结局相关。结果如下：发现国际膝关节文献委员会评分从术前的47.25 +/- 18.71分显著持续增加至HTO后36个月的72.72 +/- 17.15分（P < .001）。内侧间室的软骨损伤程度和外侧间室的部分厚度缺损对临床结果没有显著影响（在所有时间点P > 0.05）。胫骨内翻角与HTO后更大的改善和更好的临床结局显著相关（P <0.01）。总体并发症发生率为8.6%，主要与手术原因相关;然而，在随访期间的某个时间点，有很高比例的患者报告了与植入物相关的不适（40.6%）。结论：使用TomoFix系统行开放楔形截骨术可获得可靠的3年结果。结果不依赖于内侧软骨缺损的严重程度，而外侧间室的部分厚度缺损似乎耐受良好。髌股软骨缺损的预后相关性尚不清楚。在大量患者中观察到植入物的局部刺激。证据等级：IV级，治疗病例系列。
Purpose: Our purpose was to evaluate the 3-year clinical results of patients with medial-compartment osteoarthritis of the knee and varus malalignment who underwent open-wedge high tibial osteotomy (HTO) with an internal plate fixator (TomoFix; Synthes, Solothurn, Switzerland). Clinical results are correlated with arthroscopic and radiographic findings at the time of surgery. Methods: This study included 69 patients with a minimum follow-up of 36 months who underwent open-wedge HTO for medial-compartment osteoarthritis of the knee. Knee function was assessed before surgery and at 6, 12, 24, and 36 months after HTO by use of subjective International Knee Documentation Committee and Lysholm scores. Arthroscopic findings before HTO and radiographic assessment of the metaphyseal deformity of the proximal tibia (tibial bone varus angle) were correlated with clinical outcome. Results: A significant continuous increase in International Knee Documentation Committee score from 47.25 +/- 18.71 points before surgery to 72.72 +/- 17.15 points at 36 months after HTO was found (P < .001). Grade of cartilage damage of the medial compartment and partial-thickness defects of the lateral compartment did not significantly influence clinical outcome (P > .05 at all time points). The tibial bone varus angle was correlated significantly with greater improvement and better clinical outcome after HTO (P < .01). The overall complication rate of 8.6% was mostly related to surgical causes; nevertheless, a high proportion of patients reported discomfort related to the implant at some point during the follow-up period (40.6%). Conclusions: Open-wedge osteotomy by use of the TomoFix system leads to reliable 3-year results. Results do not depend on the severity of medial cartilage defects, whereas partial-thickness defects of the lateral compartment seem to be well tolerated. The prognostic relevance of patellofemoral cartilage defects remains unclear. Local irritation of the implant was observed in a significant number of patients. Level of Evidence: Level IV, therapeutic case series.