胫骨高位截骨术对髌股关节软骨病变的影响

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Abstract Objective To evaluate the effect of open wedge high tibial osteotomy (OWHTO) on the patellofemoral joint according to the preexisting patellofemoral arthritis.Methods A total of 86 patients with unilateral varus knee osteoarthritis and patellofemoral osteoarthritis who underwent arthroscopy and OWHTO between January 2014 and December 2018 were evaluated retrospectively.The patients were stage Ⅰ~Ⅲ according to Iwano's classification.All the patients with knee osteoarthritis consistent with medial pain but no patellofemoral joint symptoms，the anteroposterior radiograph showed medial compartment osteoarthritis of the knee and the patellofemoral space narrowing was observed on lateral and axial radiographs of the patella.The patients were divided into two groups according to the arthroscopic view of cartilage statusof the patellofemoral joint.There were35 patients in group A ［international cartilage repair society (ICRS) grade 0~Ⅰ］，including 9 males and 26 females.The average age was (55.66±4.66).There were 51 patients in group B (ICRS grade Ⅱ~Ⅲ)，including 21 males and 30 females.The average age was (55.90±4.44).All patients underwent OWHTO and they were recommended to remove the internal fixation plate when the osteotomy space was healed.Patients in the two groups were compared at the time of primary osteotomy and the time of reremoval of internal fixation，the evaluation included the visual analogue scale(VAS)，Western Ontario and McMaster universities score (WOMAC) and the scoring of patellofemoral disorders(Kujala).Iwano's classification and the ICRS grading were compared between each group before and after osteotomy. Results There were statistically significant differences in VAS score，WOMAC score and Kujala score between the two groups at the time of two operations (P＜0.05).Compared with the initial operation，the ICRS grade showed a tendency to progress at the second-look operation，but without statistical significance in Iwano's classification and the ICRS grading system (P＞0.05).The noninferiority test showed that the Kujala score of group B was not worse than group A.Conclusion Patients with varus knee osteoarthritis without patellofemoral joint symptoms，the presence of cartilage lesion of ICRS grade 0~Ⅲ in the patellofemoral joint，will not affect the surgical outcome of OWHTO in short-term follow-up，and the functional scores will be improved.

Key words： tibia osteotomy osteoarthritis knee varus patellofemoral joint

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