{"title":"胫骨截骨术治疗关节内翻:22年生存与失败分析","authors":"T. R. Sprenger, J. Doerzbacher","doi":"10.2106/00004623-200303000-00011","DOIUrl":null,"url":null,"abstract":"Background: The purpose of this retrospective study was to assess the long-term results after the treatment of medial compartment gonarthrosis with a proximal tibial osteotomy to determine whether various clinical and radiographic factors relate to the outcome. Methods: From 1972 to 1990, seventy-six valgus-producing high tibial osteotomies were performed in sixty-six patients with medial compartment gonarthrosis. Stabilization was achieved with use of a plate on the lateral side of the proximal part of the tibia and a figure-of-eight wire on the medial side. The mean age of the patients at the time of surgery was sixty-nine years, and the mean duration of follow-up was 10.8 years. The factors that were analyzed included postoperative valgus alignment; the age, gender, and weight of the patient; preoperative Ahlbäck radiographic grade; adverse events; Workers' Compensation status; and public liability. Survivorship outcome end points were conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction with the procedure. Results: Ten-year survival, according to the life-table method, was 74%, 70%, and 65% with conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction, respectively, as the end points. Radiographic valgus alignment that ranged between 8° and 16° at one year after the osteotomy had the most significant positive effect on survivorship for all end points (p < 0.01) compared with the other parameters. Complications occurred in sixteen (21%) of the seventy-six procedures, and they had a significant effect on survival, with all three end points (p < 0.05). Conclusions: We found that survival at ten years was 90% (95% confidence interval, 80% to 99%) when the radiographic valgus angle at one year was between 8° and 16° with arthroplasty as the end point. We believe that there is a role for tibial osteotomy, as an alternative to total knee arthroplasty, in patients who are less than sixty years old. Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"10 1","pages":"469–474"},"PeriodicalIF":0.0000,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"396","resultStr":"{\"title\":\"Tibial Osteotomy for the Treatment of Varus Gonarthrosis: Survival and Failure Analysis to Twenty-two Years\",\"authors\":\"T. R. Sprenger, J. Doerzbacher\",\"doi\":\"10.2106/00004623-200303000-00011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: The purpose of this retrospective study was to assess the long-term results after the treatment of medial compartment gonarthrosis with a proximal tibial osteotomy to determine whether various clinical and radiographic factors relate to the outcome. Methods: From 1972 to 1990, seventy-six valgus-producing high tibial osteotomies were performed in sixty-six patients with medial compartment gonarthrosis. Stabilization was achieved with use of a plate on the lateral side of the proximal part of the tibia and a figure-of-eight wire on the medial side. The mean age of the patients at the time of surgery was sixty-nine years, and the mean duration of follow-up was 10.8 years. The factors that were analyzed included postoperative valgus alignment; the age, gender, and weight of the patient; preoperative Ahlbäck radiographic grade; adverse events; Workers' Compensation status; and public liability. Survivorship outcome end points were conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction with the procedure. Results: Ten-year survival, according to the life-table method, was 74%, 70%, and 65% with conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction, respectively, as the end points. Radiographic valgus alignment that ranged between 8° and 16° at one year after the osteotomy had the most significant positive effect on survivorship for all end points (p < 0.01) compared with the other parameters. Complications occurred in sixteen (21%) of the seventy-six procedures, and they had a significant effect on survival, with all three end points (p < 0.05). Conclusions: We found that survival at ten years was 90% (95% confidence interval, 80% to 99%) when the radiographic valgus angle at one year was between 8° and 16° with arthroplasty as the end point. We believe that there is a role for tibial osteotomy, as an alternative to total knee arthroplasty, in patients who are less than sixty years old. Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.\",\"PeriodicalId\":22625,\"journal\":{\"name\":\"The Journal of Bone & Joint Surgery\",\"volume\":\"10 1\",\"pages\":\"469–474\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2003-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"396\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Journal of Bone & Joint Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2106/00004623-200303000-00011\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of Bone & Joint Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/00004623-200303000-00011","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Tibial Osteotomy for the Treatment of Varus Gonarthrosis: Survival and Failure Analysis to Twenty-two Years
Background: The purpose of this retrospective study was to assess the long-term results after the treatment of medial compartment gonarthrosis with a proximal tibial osteotomy to determine whether various clinical and radiographic factors relate to the outcome. Methods: From 1972 to 1990, seventy-six valgus-producing high tibial osteotomies were performed in sixty-six patients with medial compartment gonarthrosis. Stabilization was achieved with use of a plate on the lateral side of the proximal part of the tibia and a figure-of-eight wire on the medial side. The mean age of the patients at the time of surgery was sixty-nine years, and the mean duration of follow-up was 10.8 years. The factors that were analyzed included postoperative valgus alignment; the age, gender, and weight of the patient; preoperative Ahlbäck radiographic grade; adverse events; Workers' Compensation status; and public liability. Survivorship outcome end points were conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction with the procedure. Results: Ten-year survival, according to the life-table method, was 74%, 70%, and 65% with conversion to arthroplasty, a Hospital for Special Surgery knee score of <70 points, and patient dissatisfaction, respectively, as the end points. Radiographic valgus alignment that ranged between 8° and 16° at one year after the osteotomy had the most significant positive effect on survivorship for all end points (p < 0.01) compared with the other parameters. Complications occurred in sixteen (21%) of the seventy-six procedures, and they had a significant effect on survival, with all three end points (p < 0.05). Conclusions: We found that survival at ten years was 90% (95% confidence interval, 80% to 99%) when the radiographic valgus angle at one year was between 8° and 16° with arthroplasty as the end point. We believe that there is a role for tibial osteotomy, as an alternative to total knee arthroplasty, in patients who are less than sixty years old. Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.