开放楔胫骨高位截骨术对髌骨位置与关节功能的影响

Effect of open wedge tibial high osteotomy on patella position and joint function

目的:探讨开放楔胫骨高位截骨术对髌骨位置、膝前痛及关节功能的影响。方法:2016年6月至2021年6月,根据纳入和排除标准,共纳入采用开放楔胫骨高位截骨术治疗的膝关节内侧骨关节病患者109例(111膝),其中男41例,女68例;年龄38~78(57.98±7.07)岁;病程1~36(8.58±6.91)个月。观察比较手术前后股胫角(femoral tibial angle,FTA),胫骨近端内侧角(medial proximal tibial angle,MPTA),负重位力线(weight bearing line,WBL)百分比,CD指数(Caton-Deschamps index),髌骨外倾角(lateral patella tilt angle,LPTA)和髌骨外移(lateral patella shift,LPS)。采用Lysholm评分评价膝关节功能,视觉模拟评分(visual analogue scale,VAS)评价膝前痛程度,Kellgren-Lawrence(K-L)分级系统评价髌股关节骨关节炎进展情况。结果:109例患者获得随访,时间6~38(12.41±2.40)个月。术前FTA、MPTA、WBL百分比、CD指数、LPTA与末次随访时比较,差异有统计学意义(P<0.05)。LPS手术前后比较,差异无统计学意义(P=0.78)。Lysholm评分由术前的(58.79±7.90)分增加到末次随访(76.05±7.36)分(P<0.05)。膝前痛VAS由术前的(3.28±1.95)分降低到末次随访(1.07±1.75)分(P<0.05)。膝髌股关节骨关节炎呈进展性改变,但手术前后K-L分级变化比较,差异无统计学意义(P>0.05)。结论:开放楔胫骨高位截骨术后髌骨出现了位置降低和外倾,但膝关节功能和膝前痛均有显著改善。开放楔胫骨高位截骨术引起髌骨位置的不利改变可能并没有影响临床结果。

Objective:To investigate the effect of open wedge tibial high osteotomy on patella position,anterior knee pain and joint function.Methods:From June 2016 to June 2021,109 patients(111 knees)with medial knee osteoarthropathy treated by open wedge tibial high osteotomy were included according to the inclusion and exclusion criteria,including 41 males and 68 females;the age ranged from 38 to 78 years old with an average of(57.98±7.07)years;the course of disease ranged from 1 to 36 months with an average of(8.58±6.91)months.The femoral tibial angle(FTA),medial proximal tibial angle(MPTA),weight bearing line(WBL)percentage,Caton Deschamps index(CD index),lateral patella tilt angle(LPTA)and lateral patella shift(LPS)were observed and compared before and after operation.Lysholm score was used to evaluate the knee function,visual analogue scale(VAS)was used to evaluate the degree of anterior knee pain,and Kellgren Lawrence(K-L)grading system was used to evaluate the progress of patellofemoral osteoarthritis.Results:All patients were followed up for 6 to 38 months with an average of(12.41±2.40)months.The preoperative FTA,MPTA,WBL percentage,CD index,and LPTA were significantly different from those at the last follow-up(P<0.05).There was no significant difference between before and after LPS operation(P=0.78).Lysholm score increased from(58.79±7.90)scores to(76.05±7.36)scores(P<0.05).The VAS of anterior knee pain decreased from(3.28±1.95)scores to(1.07±1.75)scores(P<0.05).Knee patellofemoral osteoarthritis showed progressive changes,but there was no significant difference in K-L grading before and after operation(P>0.05).Conclusion:After open wedge tibial high osteotomy,the position of patella is lowered and the patella is tilted outward,but the knee function and anterior knee pain are significantly improved.Adverse changes in patella position caused by open wedge tibial high osteotomy may not affect clinical outcomes.