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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Tibial Tubercle Osteotomy for Anterior Knee Pain
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Tibial Tubercle Osteotomy for Anterior Knee Pain

机译：胫前结节胫骨结节截骨术

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Objectives: The aim of this study was to evaluate the mid-term radiological and clinical outcomes of tibial tubercle osteotomy in patients affected by anterior knee pain. In addition, prognostic factors correlated with the outcomes were evaluated. Methods: The patients treated with tibial tubercle osteotomy (anteromedialization) for anterior knee pain between 2002 and 2014 were included. Exclusion criteria: 1) previous knee surgeries; 2) different procedures to treat anterior knee pain; 3) history of patellar dislocation, 4) Rheumatic conditions. Different variables were collected, as shown in. The patients were prospectively evaluated using the WOMAC short form and Kujala scores. An objective evaluation was performed looking for different potential risk factors and using part of the International Knee Documentation Committee (IKDC) score. Radiological evaluation was performed, including the congruence angle, the grade of osteoarthritis (Kellegren-Lawrence) and the patellar tilt angle. Three main outcomes were identified. The multiple logistic regression was used to analyze the correlation between the variables and a worse outcome. Results: 72 cases were included in the study (9 bilateral). 72.2% of the cases were female, and the average age was 42,2 years (SD15,9). The average BMI was 24.4 kg/m2 (SD5,2). In 70.8% of patients a lateral release was associated to the tibial tubercle osteotomy. 77.8% of patients were evaluated clinically, the remaining, who were unable to come for the visits, were interviewed and the subjective scores were administered by phone. The average follow-up was 68.4 months (SD35.5).In 62.5% of cases a valgus lower limb alignment was detected, with 25% and 39.3% of patients having respectively an increased femoral antiversion and foot pronation. Post-operatively there was a statistical significant improvement in all the scores. No differences in the pre-operative and post-operative congruence angle or patellar tilt were detected (p>0.05). All the osteotomies were healed at the last follow-up. No major complications were detected. In 19 cases a further surgery was necessary, with 17 cases of hardware removal and one case of arthrofibrosis. In one case a major subsequent surgery was necessary (Total Knee Arthroplasty): the cumulative survivorship resulted equal to 92.3% (SD7.4%) at the final follow-up.At the multiple regression analysis, a lower WOMAC score was associated with increased age (> 45 years, OR=141.69), increased femoral antiversion (OR=69.94), poor post-operative muscular trophism (OR=127.61) and persistent post-operative pathologic Q angle (OR=18.84). Similarly, a lower Kujala score was associated with increased age (OR=8.36) and increased foot pronation (OR=5.10). Patients’ poor satisfaction was associated only to post-operative factors, such as presence of a positive Rabot test (OR=4.42) and poor muscolar trophism (OR=5.14). Fig.1 shows the results of regression analysis Conclusion: In this study good clinical and radiological outcomes were obtained at mid-term follow-up using tibial tubercle osteotomy to treat anterior knee pain, with a cumulative survivorship of 92.3%. The procedure did not affect radiological angles such as the congruence one or the patellar tilt. Older age, increased femoral antiversion, poor post-operative muscolar trophism, increased foot pronation and persistent pathologic Q angle were significantly correlated with worse subjective outcomes.
机译：目的：本研究的目的是评估受膝前疼痛影响的患者胫骨结节截骨术的中期放射学和临床结局。此外，评估了与预后相关的预后因素。方法：纳入2002年至2014年间接受胫骨结节截骨术（前房室置换术）治疗前膝关节疼痛的患者。排除标准：1）以前的膝盖手术; 2）治疗膝关节前疼痛的不同程序; 3）tell骨脱位史，4）风湿病。如图所示，收集了不同的变量。使用WOMAC简写形式和Kujala评分对患者进行前瞻性评估。进行客观评估以寻找不同的潜在风险因素，并使用国际膝关节文献委员会（IKDC）评分的一部分。进行放射学评估，包括全角，骨关节炎的等级（Kellegren-Lawrence）和the骨倾斜角。确定了三个主要结果。使用多元逻辑回归分析变量与较差结果之间的相关性。结果：72例被纳入研究（9例双边）。 72.2％的病例为女性，平均年龄为42.2岁（SD15,9）。平均BMI为24.4 kg / m2（SD5,2）。在70.8％的患者中，横向释放与胫骨结节截骨有关。对77.8％的患者进行了临床评估，其余患者因无法访问而进行了访谈，并通过电话进行了主观评分。平均随访时间为68.4个月（SD35.5）。在62.5％的病例中发现下肢外翻对准，分别有25％和39.3％的患者股骨抗反倾力和足内翻增加。术后所有分数均有统计学上的显着改善。术前和术后的全角或pa骨倾斜均无差异（p> 0.05）。在最后一次随访中，所有的截骨术均已治愈。没有发现重大并发症。在19例中，有必要进行进一步的手术，其中17例去除了硬件，另1例发生了关节纤维化。在一种情况下，需要进行大手术（全膝关节置换术）：最终随访时的累积生存率等于92.3％（SD7.4％）。在多元回归分析中，较低的WOMAC评分与增加相关年龄（> 45岁，OR = 141.69），股骨抗逆性增加（OR = 69.94），术后肌肉营养不良（OR = 127.61）和持续的术后病理Q角（OR = 18.84）。同样，较低的Kujala得分与年龄增加（OR = 8.36）和脚内旋增加（OR = 5.10）相关。患者的低满意度仅与术后因素有关，例如存在Rabot试验阳性（OR = 4.42）和粘膜营养不良（OR = 5.14）。图1显示了回归分析的结果结论：该研究在中期随访中使用胫骨结节截骨术治疗前膝关节疼痛获得了良好的临床和放射学结果，累计存活率为92.3％。该程序不影响放射学角度，例如全合一或tell骨倾斜。老年人，股骨抗逆性增加，术后粘膜营养不良，足前旋增加和持续的病理Q角与较差的主观预后密切相关。

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