背景:本研究的目的是描述膝关节外翻患者内侧闭合和外侧开放股骨远端截骨术(MCDFO和LODFO)的适应症和技术方面,并报告临床和放射学结果和并发症。
方法:超过6年,28个DFO(22个MCDFO,22例患者进行了6LODFO)。在这项队列研究中,我们回顾性分析了临床和放射学结果指标以及并发症.
结果:中位(范围)年龄为47(17-63)岁,高度1.68(1.56-1.98)m,体重80(49-105)kg,和体重指数(BMI)27.4(18.6-37.0)kg/m2。临床随访21(7-81)个月,术后随访59(7~108)个月,需要进行全膝关节置换或单室膝关节置换(TKA/UKA)和硬件切除.术前,髋-膝-踝角度(HKA,负值表示varus)为7.0(2.0-13.0)°,股骨远端机械外侧角(mLDFA)为83.7(79.9-88.2)°,机械近端胫骨角(MPTA)为89.0(86.6-94.5)°。术后,HKA为-1.3(-9.0-1.2)°,mLDFA为90.8(87.3-97.3)°。轻微和主要并发症的发生率分别为25%和14%,延迟愈合和不愈合的发生率分别为18%和4%,分别。在最后一次随访中,18%的患者在休息时出现疼痛,25%在日常生活活动中,39%在体力活动中,71%的人对结果感到满意。7%的病例接收了TKA/UKA,71%的人接受了硬件移除。
结论:DFO是治疗年轻患者外侧骨关节炎的合理方法,可避免疾病进展和UKA/TKA的需要。然而,有很长的康复时间,有相当大的并发症风险,以及对硬件移除的高需求。虽然许多患者在长期随访中出现症状,大多数人对结果感到满意。适当的患者信息至关重要。证据级别IV级,案例系列。试验注册号NCT04382118,clinicaltrials.gov,2020年5月11日。
BACKGROUND: The aim of this study was to describe the indications and technical aspects of medial closing and lateral opening distal femoral osteotomy (MCDFO and LODFO) for patients with a valgus knee and to report clinical and radiological outcomes and complications.
METHODS: Over 6 years, 28 DFOs (22 MCDFO, 6 LODFO) were performed in 22 Patients. In this cohort study, we retrospectively analyzed clinical and radiological outcome measures as well as complications.
RESULTS: The median (range) age was 47 (17-63) years, height 1.68 (1.56-1.98) m, body mass 80 (49-105) kg, and body mass index (BMI) 27.4 (18.6-37.0) kg/m2. The clinical follow-up was 21 (7-81) months, the need for total or unicompartmental knee arthroplasty (TKA/UKA) and hardware removal was followed up for 59 (7-108) months postoperatively. Preoperatively, hip-knee-ankle angle (HKA, negative values denote varus) was 7.0 (2.0-13.0)°, mechanical lateral distal femoral angle (mLDFA) was 83.7 (79.9-88.2)°, and mechanical proximal tibial angle (MPTA) was 89.0 (86.6-94.5)°. Postoperatively, HKA was -1.3 (-9.0-1.2)° and mLDFA was 90.8 (87.3-97.3)°. The incidence of minor and major complications was 25% and 14%, the incidence of delayed and nonunion was 18% and 4%, respectively. At the last follow-up, 18% of the patients had pain at rest, 25% during activities of daily living, and 39% during physical activity, and 71% were satisfied with the outcome. 7% of the cases received a TKA/UKA, 71% received a hardware removal.
CONCLUSIONS: DFO is a reasonable treatment for lateral osteoarthritis in younger patients to avoid disease progression and the need for an UKA/TKA. However, there is a long rehabilitation time, a considerable risk for complications, and a high need for hardware removal. While many patients experienced symptoms at the long-term follow-up, most were satisfied with the outcome. Appropriate patient information is essential. Level of evidence Level IV, Case Series. Trial registration number NCT04382118, clinicaltrials.gov, May 11, 2020.