胫骨结节远端单平面截骨术对髌骨高度的影响

doi:10.3877/cma.j.issn.1674-134X.2020.05.007

目的

观察胫骨结节远端单平面截骨术对髌骨高度的影响。

方法

选取2017年8月至2018年10月于北京中医药大学第三附属医院微创关节科行胫骨结节远端单平面截骨术患者68例；其中男13例，女55例，年龄(64±7)岁。纳入标准：髌骨位置无严重偏移且术后随访资料完整；排除标准：关节镜对髌股关节进行干预治疗；严重膝关节韧带损伤伴功能不全；严重其他骨病；既往膝关节手术史；随访术肢并发二次损伤。采用Caton-Deschamps指数(CDI)、股骨髌骨高度指数(FPHI)评估髌骨高度的变化，髌骨轴位45°X线片Kellgren-Lawrence(K-L)分级评估髌股关节退化程度；采用美国特种外科医院评分(HSS)评估膝关节功能。使用重复测量的方差分析与卡方检验进行统计学分析。

结果

68例患者均获得随访，随访时间(17±5)个月。CDI由术前的(0.94 ±0.14)改善为术后1周、术后12月时(0.91±0.21)、(0.89±0.17)(F＝0.451，P>0.05)；FPHI由术前的(1.51±0.22)改善为术后1周、术后12月的(1.52±0.17)、(1.52±0.21)(F＝0.782，P>0.05)；髌股关节K-L分级术前、术后1周及术后12月时无显著变化(χ² ＝0.479，P＝0.628)。HSS评分由术前(52±16)改善为术后3、12个月的(69±11)、(83±7)，差异有统计学意义(F＝282.638，P<0.001)。

结论

胫骨结节远端单平面截骨术对髌骨高度无明显影响，髌股关节未见显著退化。

关键词: 髌骨, 截骨术, 膝, 骨关节炎

Objective

To evaluate the effect of distal tibial tuberosity-high tibial osteotomy on patella height.

Methods

Sixty-eight patients was included in the study who were treated with distal tibial tuberosity-high tibial osteotomy from August 2017 to October 2018, including 13 males and 55 females, average age (64±7) years. The inclusion criteria were patella without severe deviations in positioning and complete postoperativefollow-up data. The exclusion criteria were as follows: (1) arthroscopy before DTT-HTO for patellofemoral joint, (2) severe ligament injury of the affected knee joint, (3) severe osteoporosis or rheumatoid arthritis, (4) history of surgery onthe affected knee before DTT-HTO and (5) secondary injuries of the affected knee during the follow-up period.The Caton-Deschamps index(CDI), femoral patella height index(FPHI) and the Kellgren-Lawrence scale were used to evaluate the effect of surgery on the patellar height andthe degeneration of patellofemoral joint. Hospital for Special Surgery scale (HSS) were used to evaluatethe function of knee joint. Statistical analysis was performed using ANOVA with repeated measurement and chi-square test.

Results

All 68 patients were followed up for (17±5) months. The CDI was improved from (0.94±0.14) preoperatively to (0.91±0.21) and (0.89±0.17)at one week and 12 months postoperatively (F=0.451, P=0.244). The FPHI improved from (1.51±0.22)preoperatively to (1.52±0.17) and (1.52±0.21) at one week and 12 months postoperatively (F=0.782, P>0.05). There was no significant change in Kellgren-Lawrence scale preoperatively, one week and 12 months postoperatively(χ² =0.479, P>0.05). The HSS score increased from (52±16) preoperatively to (69±11) and (83±7)at three and 12 months postoperatively (F=282.638, P<0.001).

Conclusion

Distal tibial tuberosity-high tibial osteotomy has no significant effect on the patellar height and the degradation of patellofemoral joint.

Key words: Patella, Osteotomy, Knee, Osteoarthritis

图1 胫骨结节远端截骨手术示意图。图A示通过定位确定截骨线经过胫骨结节远端，避免影响髌骨高度及髌韧带；图B示暴露胫骨并沿截骨线截骨；图C为C臂透视下辅助撑开截骨，截骨区位置对胫骨结节影响不大；图D示角度满意后π型锁定金属板固定

图2 放射学指标测量示意图。图A为膝关节屈曲30°侧位X线片，CDI(Caton-Deschamps指数)(髌骨关节面远端至胫骨前上角的距离除以髌骨关节面的长度)＝B/A；图B为膝关节负重正位X线片中，FPHI指数(股骨内上髁与外上髁切线的垂直距离除以髌骨上极与股骨内外髁关节面切线的垂直距离)＝C/D

图3 膝关节髌骨轴位45°X线片

表1 胫骨结节远端单平面截骨手术前后影像学结果比较(n＝68)

	术前	术后1周	术后12月	统计值	P值
CDI指数(±s)	0.94±0.14	0.91±0.21	0.89±0.17	F＝0.451	>0.05
FPHI指数(±s)	1.51±0.22	1.52±0.17	1.52±0.21	F＝0.782	>0.05
K-L分级[例(%)]
0级	4(5.9)	5(7.3)	2(2.9)	χ²＝0.479	>0.05
Ⅰ级	35(51.5)	33(48.5)	36(52.9)
Ⅱ级	29(42.7)	30(44.1)	28(41.2)
Ⅲ级	0(0)	0(0)	2(2.9)

表1 胫骨结节远端单平面截骨手术前后影像学结果比较(n＝68)

	术前	术后1周	术后12月	统计值	P值
CDI指数(±s)	0.94±0.14	0.91±0.21	0.89±0.17	F＝0.451	>0.05
FPHI指数(±s)	1.51±0.22	1.52±0.17	1.52±0.21	F＝0.782	>0.05
K-L分级[例(%)]
0级	4(5.9)	5(7.3)	2(2.9)	χ²＝0.479	>0.05
Ⅰ级	35(51.5)	33(48.5)	36(52.9)
Ⅱ级	29(42.7)	30(44.1)	28(41.2)
Ⅲ级	0(0)	0(0)	2(2.9)

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Effect of Distal tibial tuberosity-high tibial osteotomy on patella height

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Effect of Distal tibial tuberosity-high tibial osteotomy on patella height