开放楔胫骨高位截骨术联合关节镜下髌股外侧支持带松解术对髌骨位置的影响

Influence of open wedge tibial high osteotomy combined with arthroscopic patellofemoral lateral retinaculum release on patellar position

目的:评估开放楔胫骨高位截骨术联合关节镜下髌股外侧支持带松解术对髌骨位置及髌股关节骨关节炎的影响。方法:回顾性分析2016年9月至2021年5月采用开放楔胫骨高位截骨术联合髌股外侧支持带松解术治疗的31例膝关节内侧骨关节炎合并髌股关节骨关节炎患者的临床资料,其中男8例,女23例;年龄39~71岁,平均(56.9±7.9)岁;病程1.5~38个月,平均(13.4±7.4)个月。比较手术前后股胫角(FTA)、胫骨近端内侧角(MPTA)、负重位力线(WBL)百分比、Caton-Deschamps(CD)指数、Insall-Salvati(IS)指数、髌骨外倾角(LPTA)和髌骨外移(LPS)。采用Kellgren-Lawrence(KL)分级系统评价髌股关节骨关节炎进展情况。结果:31例患者随访6~38个月,平均(13.7±10.0)个月。所有患者未发生死亡、骨不愈合、血管神经损伤、感染、深静脉血栓、皮肤烧灼伤、内侧髌骨脱位等严重并发症。与术前相比,末次随访时FTA由内翻7.43°±2.65°变为外翻2.77°±1.53°,MPTA由82.26°±1.93°增加到90.73±2.71°,WBL百分比由16.75%±12.88%增加到58.06%±10.13%,CD指数从0.96±0.16减小到0.89±0.09,IS指数从1.06±0.14减小到0.97±0.13,LPTA由9.89°±4.13°降至6.43°±3.29°(P=0.007),LPS由(3.32±2.93)mm变小为(1.76±1.20)mm。手术前后上述参数比较差异均有统计学意义(P<0.05)。末次随访时2例患者KL分级由术前的Ⅲ级降为Ⅱ级,但手术前后KL分级比较,差异无统计学意义(P>0.05)。结论:开放楔胫骨高位截骨术联合关节镜下髌股外侧支持带松解术后髌骨高度降低,但髌骨外倾和外移明显减轻,髌股关节骨关节炎无进展性改变。同期关节镜下髌股外侧支持带松解术对开放楔胫骨高位截骨术后髌骨位置的变化有改善作用。

Objective:To evaluate the effect of open wedge high tibial osteotomy(OWHTO)combined with patellofemoral lateral retinaculum release(LRR)on patellar position and patellofemoral osteoarthritis.Methods:Clinical data of 31 patients(31 knees)with medial knee osteoarthritis and patellofemoral osteoarthritis treated with OWHTO combined with patellofemoral LRR from September 2016 to May 2021 were retrospectively analyzed.There were 8 males and 23 females with a mean age of(56.9±7.9)years(range,39-71 years).The mean disease duration was(13.4±7.4)months(range,1.5-38 months).The femoral tibial angle(FTA),medial proximal tibial angle(MPTA),weight bearing line(WBL)percentage,Caton-Deschamps index(CD index),Insall-Salvati index(IS index),lateral patella tilt angle(LPTA)and lateral patella shift(LPS)were compared before and after surgery.The Kellgren-Lawrence(KL)grading system was used to evaluate the progression of patellofemoral osteoarthritis.Results:Thirty-one patients were followed up for 6 to 38 months with an average of(13.7±10.0)months.No serious complications such as death,bone nonunion,vascular or nerve injury,infection,deep vein thrombosis,skin burn,medial patellar dislocation occurred.There were significant differences in these indexes before and after surgery(FTA:varus 7.43°±2.65°vs.valgus 2.77°±1.53°,MPTA:82.26°±1.93°vs.90.73°±2.71°,WBL percentage:16.75%±12.88%vs.58.06%±10.13%,CD index:0.96±0.16 vs.0.89±0.09,IS index:1.06±0.14 vs.0.97±0.13,LPTA:9.89°±4.13°vs.6.43°±3.29°,LPS:[3.32±2.93]mm vs.[1.76±1.20]mm,P<0.05).The KL grade of 2 patients changed from levelⅢto levelⅡ,but there was no significant difference in KL grade in all the patients before and after surgery(P>0.05).Conclusions:After OWHTO combined with patellofemoral LRR,patellar descent was observed,but patellar lateral tilt and shift were reduced,and there was no progressive change in patellofemoral osteoarthritis.Patellofemoral LRR has a positive effect on the improvement of patellar position after OWHTO.