Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results.
Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results.
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DOI：
10.1007/s00402-016-2609-3
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发表时间：
2017-03
影响因子：
2.3
通讯作者：
Chiba G
中科院分区：
文献类型：
--
作者：
Chiba K;Yonekura A;Miyamoto T;Osaki M;Chiba G
胫骨髁外翻截骨术（TCVO）是一种开放楔形胫骨高位截骨术，用于治疗伴有外侧关节半脱位的晚期膝关节内侧骨关节炎（OA）。我们报告这个概念，目前的手术技术与锁定钢板，和短期临床和放射学结果。11例膝关节内侧OA和外侧关节加宽采用TCVO治疗（KL期III: 6， IV: 5）。在该手术中，通过从胫骨近端内侧到髁间隆起的l形截骨和外翻矫正，获得机械轴偏侧和半脱位外侧关节复位，术后早期负重。术前、术后6个月、1年和5年，分别采用视觉模拟量表（VAS）、西安大略省和麦克马斯特大学关节炎指数（WOMAC）、下肢对线、股胫关节的一致性和稳定性进行观察。术前至术后5年，VAS评分由平均73 mm提高至13 mm， WOMAC总分由52分提高至14分。机械轴从1°变为60%，FTA从186°变为171°。关节线收敛角（JLCA）由6°变为1°，内翻应力与外翻应力之间的JLCA角差由8°减小到4°。通过TCVO观察到疼痛和日常生活活动的改善，以及下肢外翻矫正和股胫关节的稳定。
Tibial condylar valgus osteotomy (TCVO) is a type of opening-wedge high tibial osteotomy for advanced medial knee osteoarthritis (OA) with subluxated lateral joint. We report the concept, the current surgical technique with a locking plate, and the short-term clinical and radiological results of this procedure. 11 knees with medial OA and a widened lateral joint were treated by TCVO (KL stage III: 6, IV: 5). In this procedure, by the L-shaped osteotomy from the medial side of the proximal tibia to the intercondylar eminence and the valgus correction, lateralization of the mechanical axis and reduction of the subluxated lateral joint are obtained with early postoperative weight-bearing. Before, 6 months, 1, and 5 years after the operation, a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), alignment of the lower extremity, and congruency and stability of the femorotibial joint were investigated. The VAS improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively. The mechanical axis changed from 1 to 60%, and the FTA changed from 186° to 171°. The joint line convergence angle (JLCA) changed from 6° to 1°, and the angle difference of JLCA between varus and valgus stress improved from 8° to 4° after the procedure. Improvements in pain and activities of daily living were observed by TCVO along with valgus correction of the lower extremity and stabilization of the femorotibial joint.