■在外翻对准和侧室退行性改变的患者中,股骨远端截骨(DFO)和胫骨高位截骨(HTO)均可用于卸载外侧室。先前的研究表明,在膝盖外翻中,胫骨磨损是后部的,DFO在伸展方面发挥最大的作用;然而,其效果随着屈曲角度的增加而降低。
■中间封闭楔(MCW)HTO将大大减少接触面积,平均接触压力(MCP),与外侧开放楔形(LOW)DFO相比,通过膝关节屈曲在外侧膝关节室中的峰值接触压力(PCP)更大。
■对照实验室研究。
■执行了MCWHTO和LOWDFO,校正平均8°外翻对齐,在10个尸体膝盖使用钢板固定。以0°测量内侧和外侧隔室的胫骨股接触压力,30°,60°,在截骨前后使用薄的电子传感器和通过Instron装置施加的载荷进行膝关节屈曲90°。PCP,MCP,并测量每个条件下的接触面积。
■与30°的天然状态相比,HTO状态下的横向MCP显着降低(P=.015),60°(P=.0199),屈曲90°(P<.0001)。当在60°(P=.0093)和90°屈曲(P<.0001)时,与DFO状态相比,在HTO状态下侧向MCP也显著降低。DFO之后,侧位MCP在屈曲60°(P>.999)和90°(P>.999)时恢复到原始状态。在所有屈曲度的所有测试状态下,侧向PCP均降低;与60°(P<.0001)和90°(P<.0001)的原始状态相比,HTO状态显着降低。
■使用8°的内翻校正,MCOWHTO在卸载横向隔间方面比LOWDFO更有效。随着膝关节屈曲角度的增加,这种效果很明显。这项研究应被视为手术决策过程的一个方面。
■在轻度至中度外翻畸形,无股骨外侧髁发育不良且无明显关节线倾斜的患者中,MCWHTO可以改善外侧隔室在屈曲中的卸载。
UNASSIGNED: In patients with valgus alignment and degenerative changes in the lateral compartment, both distal femoral osteotomy (DFO) and high tibial osteotomy (HTO) can be used to unload the lateral compartment. Prior studies have shown that in valgus knees, the tibial wear is posterior and DFO exerts the greatest effect in extension; however, its effect is decreased as flexion angle rises.
UNASSIGNED: Medial closing-wedge (MCW) HTO would significantly decrease contact area, mean contact pressure (MCP), and peak contact pressure (PCP) in the lateral knee compartment through knee flexion to a greater extent compared with lateral opening-wedge (LOW) DFO.
UNASSIGNED: Controlled laboratory study.
UNASSIGNED: MCWHTO and LOWDFO were performed, correcting a mean of 8° of valgus alignment, in 10 cadaveric knees using plate fixation. Tibiofemoral contact pressure of the medial and lateral compartments was measured in 0°, 30°, 60°, and 90° of knee flexion before and after osteotomy using thin electronic sensors and load applied through an Instron device. PCP, MCP, and contact area were measured for each condition.
UNASSIGNED: The lateral MCP was significantly decreased in the HTO state compared with the native state in 30° (P = .015), 60° (P = .0199), and 90° (P < .0001) of flexion. The lateral MCP was also significantly decreased in the HTO state when compared with the DFO state in 60° (P = .0093) and 90° of flexion (P < .0001). After DFO, the lateral MCP returned to that of the native state in 60° (P > .999) and 90° (P > .999) of flexion. The lateral PCP decreased for all test states in all degrees of flexion; the HTO state was significantly decreased when compared with the native state in 60° (P < .0001) and 90° (P < .0001).
UNASSIGNED: With varus corrections of 8°, MCWHTO was more effective at unloading the lateral compartment than LOWDFO. This effect was significant as the knee flexion angle increased. This study should be considered as one aspect of the surgical decision-making process.
UNASSIGNED: In patients with mild to moderate valgus deformity without hypoplastic lateral femoral condyle and without significant joint line obliquity, MCWHTO may improve offloading of the lateral compartment in flexion.