目的:欧洲共识的目的是为使用关节保留方法治疗退行性膝内翻疼痛患者提供建议。第二部分集中在手术上,胫骨或股骨矫正截骨术后的康复和并发症。
方法:来自欧洲24个国家的94名骨科医生参与了共识,重点是膝盖周围的截骨术。共识是根据欧洲运动创伤学会进行的,膝关节手术和关节镜检查共识方法。指导小组根据专家的经验和文献证据设计了问题并编写了声明。在发布最终共识之前,由同行评审小组的评级对声明进行了评估。
结果:内侧开口楔形胫骨高位截骨术(MOWHTO)的理想铰链位置应位于近端胫腓关节的上水平,并用于股骨内侧髁上方的外侧闭合楔形股骨远端截骨术(LCWDFO)。铰链保护不是强制性的。双平面截骨切口为MOWHTO和LCWDFO提供更高的稳定性和更快的骨结合,特别推荐用于后者。截骨间隙填充不是强制性的,除非需要结构增强稳定性。对于复杂病例,应由经验丰富的双手保留特定于患者的仪器。截骨术后可采用早期完全负重,不管技术。然而,DFO患者应格外小心.截骨患者应在6个月内恢复运动。
结论:明确的手术策略建议,显示了疼痛性退行性膝内翻的膝关节截骨术的康复和并发症。在共识的第二部分,欧洲各地的专家达成了高水平的协议,在可变的工作条件下。在科学有限的地方,合作者整理的专业知识旨在为整形外科医生提供指导,以培养对该领域的兴趣,并突出潜在的未来研究领域。
方法:二级,共识。
OBJECTIVE: The purpose of the European
consensus was to provide recommendations for the treatment of patients with a painful degenerative varus knee using a joint preservation approach. Part II focused on surgery, rehabilitation and complications after tibial or femoral correction osteotomy.
METHODS: Ninety-four orthopaedic surgeons from 24 countries across Europe were involved in the consensus, which focused on osteotomies around the knee. The
consensus was performed according to the European Society for Sports Traumatology, Knee Surgery and Arthroscopy
consensus methodology. The steering group designed the questions and prepared the statements based on the experience of the experts and the evidence of the literature. The statements were evaluated by the ratings of the peer-review groups before a final consensus was released.
RESULTS: The ideal hinge position for medial opening wedge high tibial osteotomy (MOW HTO) should be at the upper level of the proximal tibiofibular joint, and for lateral closing wedge distal femoral osteotomy (LCW DFO) just above the medial femoral condyle. Hinge protection is not mandatory. Biplanar osteotomy cuts provide more stability and quicker bony union for both MOW HTO and LCW DFO and are especially recommended for the latter. Osteotomy gap filling is not mandatory, unless structural augmentation for stability is required. Patient-specific instrumentation should be reserved for complex cases by experienced hands. Early full weight-bearing can be adopted after osteotomy, regardless of the technique. However, extra caution should be exercised in DFO patients. Osteotomy patients should return to sports within 6 months.
CONCLUSIONS: Clear recommendations for surgical strategy, rehabilitation and complications of knee osteotomies for the painful degenerative varus knee were demonstrated. In Part 2 of the
consensus, high levels of agreement were reached by experts throughout Europe, under variable working conditions. Where science is limited, the collated expertise of the collaborators aimed at providing guidance for orthopaedic surgeons developing an interest in the field and highlighting areas for potential future research.
METHODS: Level II,
consensus.