胫骨近端前方闭合楔形截骨术在前交叉韧带重建中的应用

Wen-Chuan Zhao, Hong Chen, Yi-Xin Li, Jun-Wei Wang
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引用次数: 0

摘要

导言胫骨后斜度(PTS)对膝关节稳定性起着至关重要的作用。如果胫骨后斜度超过 12°,可能会增加原生前十字韧带(ACL)纤维的负荷。为了处理 PTS 度变化引起的不稳定性,外科医生采用了胫骨近端前闭合楔形截骨术(PT-ACWO)。方法在 2015 年 10 月至 2019 年 10 月期间,我科对前交叉韧带重建(ACLR)移植失败的患者进行了回顾性分析,尤其关注病理性 PTS。从初次前交叉韧带重建到翻修的时间从 1 年到 10 年不等,平均为 2.5 年。对 PTS 进行了放射学评估,并使用国际膝关节文献委员会 (IKDC) 评分、Lysholm 评分和 Tegner 活动量表对结果进行了量化。概述了手术技巧和三维患者专用器械(PSI)的使用。术前成像包括使用 Kirschner 线建立胫骨平台参考点,并使用 3D-PSI 指导胫骨截骨的位置和深度,截骨是斜向进行的。结果 在平均随访 28.1 个月的 7 例患者中,术后 PTS 显著降低(中位数[四分位间范围,IQR],从 15.27° [13.46°, 16.60°] 降至 6.25° [5.89°, 6.78°];P = 0.002)。最后随访时,IKDC 评分提高到 85.10(80.25,88.10),P < 0.001;Lysholm 评分提高到 88.00(73.00,90.50),P < 0.001;Tegner 评分提高到 8.00(7.20,8.05),P = 0.025。有两次皮肤切口愈合延迟,但都在六周前愈合。三个月后的X光片显示,斜行截骨术的骨愈合速度快于横行截骨术。膝关节保持稳定,未发现其他并发症或不稳定迹象。磁共振成像(MRI)证实所有患者的移植物都是完整的,在最后一次观察时没有增大或错位的迹象。对于此类患者,实施 ACLR 并结合 PT-ACWO 可降低首次 ACLR 或后续翻修手术中手术失败的风险。
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The application of proximal tibial anterior closing wedge osteotomy in anterior cruciate ligament reconstruction

Introduction

Posterior tibial slope (PTS) plays a vital role in knee stability. PTS of more than 12° may be considered with increased strain on the native anterior cruciate ligament (ACL) fibers. To handle the instability caused by changes in PTS degree, Proximal Tibial Anterior Closing Wedge Osteotomy (PT-ACWO) is adopted by surgeons.

Methods

Between October 2015 and October 2019, our department conducted a retrospective analysis of patients who experienced anterior cruciate ligament reconstruction (ACLR) graft failures, with a particular focus on pathological PTS. The time from initial ACLR to revision ranged from 1 to 10 years, with a mean of 2.5 years. Radiological assessments of PTS were conducted, and outcomes were quantified using the International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale. The surgical technique and the use of 3D Patient-Specific Instrumentation (PSI) were outlined. Preoperative imaging included the use of Kirschner wires to establish tibial plateau reference points, and 3D-PSI was employed to guide the location and depth of the tibial osteotomy, which was performed obliquely. In a notable instance, a novel tibial tunnel was mapped out, and ortho-bridge system (OBS) fixation was utilized to ensure adequate space for the new tunnel.

Results

In a cohort of seven patients with a mean follow-up of 28.1 months, a significant reduction in PTS was noted postoperatively (median [interquartile range, IQR], from 15.27° [13.46°, 16.60°] to 6.25° [5.89°, 6.78°]; P = 0.002). IKDC score improved to 85.10 (80.25, 88.10), P < 0.001; the Lysholm score to 88.00 (73.00, 90.50), P < 0.001; and the Tegner score to 8.00 (7.20, 8.05), P = 0.025 at final follow-up. Skin incision healing delays occurred in two instances, yet achieved closure by six weeks. Radiographs at three months demonstrated faster bone healing in oblique osteotomies than transverse ones. Knee joint stability was maintained, with no additional complications or evidence of instability noted. Magnetic resonance imaging (MRI) confirmed graft integrity in all patients, without signs of enlargement or mispositioning at last observation.

Conclusion

An augmented PTS angle exceeding 12 may constitute a potential etiology for the failure of ACLR grafts. In such patients, the implementation of ACLR combined with PT-ACWO could mitigate the risk of surgical failure during initial ACLR or subsequent revision procedures.

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来源期刊
CiteScore
3.80
自引率
0.00%
发文量
21
审稿时长
98 days
期刊介绍: The Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology (AP-SMART) is the official peer-reviewed, open access journal of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS) and the Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). It is published quarterly, in January, April, July and October, by Elsevier. The mission of AP-SMART is to inspire clinicians, practitioners, scientists and engineers to work towards a common goal to improve quality of life in the international community. The Journal publishes original research, reviews, editorials, perspectives, and letters to the Editor. Multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines will be the trend in the coming decades. AP-SMART provides a platform for the exchange of new clinical and scientific information in the most precise and expeditious way to achieve timely dissemination of information and cross-fertilization of ideas.
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