胫骨结节下斜式双平面截骨术对髌股关节的影响

Effect of Distal Tibial Tuberosity Open-Wedge High Tibial Osteotomy on Patellofemoral Joint

目的研究胫骨结节下斜式双平面胫骨高位截骨术(distal tibial tuberosity in open wedge high tibial osteotomy,DTT-OWHTO)对髌股关节影像学和功能评分的影响。方法自2015年1月至2019年12月于沧州市中心医院行胫骨结节下斜式双平面截骨手术治疗内翻膝骨关节炎合并髌股关节炎的患者共36例,男15例,女21例;年龄43~64岁,平均(52.96±4.59)岁。比较手术前后髌股关节Iwano分级、胫骨近端内侧角、髌骨高度、外侧髌骨角、胫骨后倾角和Lysholm评分、Kujala评分、西安大略和麦克马斯特大学(the Western Ontario and McMaster Universities,WOMAC)骨关节炎指数评分的变化。结果所有患者随访15~33个月,平均随访(23.69±4.22)个月,手术前后髌股关节Iwano分级比较差异有统计学意义(P<0.05);胫骨近端内侧角由术前(81.84±3.96)°提高到术后(90.57±2.53)°,充分矫正膝内翻;手术前后髌骨高度、外侧髌骨角和胫骨后倾角比较差异无统计学意义。Lysholm评分由术前(58.50±5.87)分提高到术后(86.39±2.14)分(P<0.05);Kujala评分由术前(56.69±9.43)分提高到术后(72.69±5.79)分(P<0.05);WOMAC评分由术前(65.19±6.48)分降低为术后(43.81±8.48)分(P<0.05)。结论胫骨结节下斜式双平面截骨可以避免髌骨低位,改善髌股关节功能。对于合并有髌股关节炎的内翻膝患者,该术式可作为其保膝治疗的有效方法。

Objective To assess the radiographic and functional scores of patellofemoral joint following a distal tibial tuberosity open-wedge high tibial osteotomy(DTT-OWHTO).Methods A total of 36 patients with varus knee osteoarthritis with patellofemoral arthritis were treated by DTT-OWHTO in our hospital,including 15 males and 21 females.The age range was(43~64)years,with an average age of(52.96±4.59)years.Changes in Iwano’s classification,medial angle of the proximal tibia(MPTA),patellar height,lateral patellofemoral angle(LPFA),tibial posterior slope(TPS),the Lysholm score,Kujala score and the Western Ontario and McMaster Universities(WOMAC)were assessed.Results All patients were followed up for(23.69±4.22)months(range:15~33 months).The Iwano’s classification of patellofemoral joint was statistically significant before and after surgery(P<0.05).The MPTA shifted from a mean(81.84±3.96)°before operation to a mean(90.57±2.53)°after operation(P<0.05).No changes in patellar height,LPFA and TPS were observed.The Lysholm score and Kujala score increased significantly from(58.50±5.87)and(56.69±9.43)before operation to(86.39±2.14)and(72.69±5.79)after operation,respectively(P<0.05).The WOMAC score decreased significantly from(65.19±6.48)preoperatively to(43.81±8.48)postoperatively(P<0.05).Conclusion DTT-OWHTO maintains the preoperative patellar height,which could help prevent progression of cartilage degeneration in the patellofemoral joint after surgery,and the radiographic as well as the clinical results support the use of this technique to treat varus knee osteoarthritis with patellofemoral arthritis.