pmjТихоокеанский медицинский журналPacific Medical Journal1609-1175TGMU10.34215/1609-1175-2023-2-31-36pmj-2514Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHESВысокая тибиальная остеотомия на 2–3-й стадиях остеоартроза как альтернатива эндопротезированию коленного суставаHigh tibial osteotomy for 2–3 stage osteoarthritis as an alternative to knee arthroplastyhttps://orcid.org/0000-0001-9946-5841КостивР. Е.KostivR. E.

Костив Роман Евгеньевич – кандидат медицинских наук, заведующий 2-м травматологическим отделением КГАУЗ ВКБ № 2, доцент Института хирургии ТГМУ.

690105, Владивосток, ул. Русская, 57; тел.: 8 (423) 232-63-93

Roman E. Kostiv - MD, PhD, Head of the 2nd Traumatology Department of Vladivostok Clinical Hospital No. 2, associate Professor of the Institute of Surgery.

57 Russkaya str., Vladivostok, 690105

kostiv2@rambler.ruШуматовВ. Б.ShumatovV. B.

Владивосток

Vladivostok

КостивЕ. П.KostivE. P.

Владивосток

Vladivostok

ПроданА. П.ProdanA. P.

Владивосток

Vladivostok

ЕмС. Л.EmS. L.

Владивосток

Vladivostok

КостиваЕ. Е.KostivаE. E.

Владивосток

Vladivostok

КондратьеваЕ. С.KondratievaE. S.

Владивосток

Vladivostok

Тихоокеанский государственный медицинский университет; Владивостокская клиническая больница № 2РоссияPacific State Medical University; Clinical City Hospital No 2Russian FederationТихоокеанский государственный медицинский университетРоссияPacific State Medical UniversityRussian FederationВладивостокская клиническая больница № 2РоссияClinical City Hospital No 2Russian Federation202314062023023136Copyright © Костив Р.Е., Шуматов В.Б., Костив Е.П., Продан А.П., Ем С.Л., Костива Е.Е., Кондратьева Е.С., 20232023Костив Р.Е., Шуматов В.Б., Костив Е.П., Продан А.П., Ем С.Л., Костива Е.Е., Кондратьева Е.С.Kostiv R.E., Shumatov V.B., Kostiv E.P., Prodan A.P., Em S.L., Kostivа E.E., Kondratieva E.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tmj-vgmu.ru/jour/article/view/2514Цель

Цель: изучение эффективности высокой тибиальной остеотомии (ВТО) при лечении остеоартроза коленного сустава 2–3-й стадии.

Материалы и методы

Материалы и методы. За период 2015–2022 гг. на базе КГАУЗ «Владивостокская клиническая больница № 2» выполнено 56 операций с применением ВТО у 49 пациентов с остеоартритом коленного сустава 2–3-й стадий. Выполняли бипланарную остеотомию выше бугристости большеберцовой кости. Фиксацию осуществляли пластинами с угловой стабильностью. Результаты оценивали по шкалам Лисхольма (Lysholm Knee Score) и ВАШ.

Результаты

Результаты. Отслежены результаты у 37 пациентов в сроки до 5 лет. Коррекция деформации достигнута в каждом случае. Отмечено стойкое уменьшение средних значений шкалы ВАШ от 1,1 до 2,7 балла. Также отмечено выраженное улучшение клинических и функциональных показателей коленного сустава по шкале LKS. Выживаемость пациентов после процедуры через 5 лет составила 100%.

Заключение

Заключение. Высокая тибиальная остеотомия является сложной процедурой, требующей длительного обучения и практики хирурга, правильной оценки показаний, тщательного предоперационного планирования и соблюдения хирургических методик. Результаты ВТО позволяют надеяться на возможность долговременной отсрочки в проведении эндопротезирования коленного сустава.

Objective

Objective. To study the effectiveness of high tibial osteotomy (HTO) in the treatment for 2–3 stage osteoarthritis of the knee.

Materials and methods

Materials and methods. Over 2015–2022 period, 56 surgeries using HTO were performed in 49 patients with knee osteoarthritis of stages 2–3 at Vladivostok Clinical City Hospital No. 2. Biplanar osteotomy was performed above the tibial tuberosity. Locking compression plates were used for fixation. The results were assessed according to the Lysholm Knee Score and VAS.

Results

Results. The follow-up results in 37 patients were monitored up to 5 years. Deformity correction was revealed in each case. The study indicated a persistent reduction in the mean values of the VAS scale from 1.1 to 2.7, as well as a significant improvement in the clinical and functional characteristics of the knee joint according to the Lysholm Knee Score. In 5 years after the procedure, the survival rate comprised 100%.

Conclusion

Conclusion. High tibial osteotomy is a complex procedure requiring long-term training and considerable experience of a surgeon, proper assessment of indications, meticulous preoperative planning, and adherence to surgical techniques. The HTO results demonstrate that a long-term delay in knee arthroplasty is feasible.

остеоартрит коленного сустававысокая тибиальная остеотомияварусная деформацияпластины с угловой стабильностьюosteoarthritis of the kneehigh tibial osteotomyvarus deformitylocking compression platesавторы заявляют о финансировании проведенного исследования из собственных средствReferencesОрлянский В., Головаха М.Л. Остеотомии в области коленного сустава. – Санкт-Петербург: СпецЛит, 2020. 328 с.Orlyansky V, Golovaha ML. Osteotomies around the knee joint. Saint-Petersburg: SpectsLit, 2020. 328 p. (In Russ.).Peng H, Ou A, Huang X, Wang C, Wang L, Yu T, Zhang Y, Zhang Y. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg. 2021;13(5):1465–73. doi: 10.1111/os.13021Peng H, Ou A, Huang X, Wang C, Wang L, Yu T, Zhang Y, Zhang Y. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg. 2021;13(5):1465–73. doi: 10.1111/os.13021Yabuuchi K, Kondo E, Onodera J, Onodera T, Yagi T, Iwasaki N, Yasuda K. Clinical Outcomes and Complications During and After Medial Open-Wedge High Tibial Osteotomy Using a Locking Plate: A 3to 7-Year Follow-up Study. Orthop J Sports Med. 2020;8(6):2325967120922535. doi: 10.1177/2325967120922535Yabuuchi K, Kondo E, Onodera J, Onodera T, Yagi T, Iwasaki N, Yasuda K. Clinical Outcomes and Complications During and After Medial Open-Wedge High Tibial Osteotomy Using a Locking Plate: A 3to 7-Year Follow-up Study. Orthop J Sports Med. 2020;8(6):2325967120922535. doi: 10.1177/2325967120922535Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585–608.Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585–608.Park HJ, Kang SB, Chang MJ, Chang CB, Jung WH, Jin H. Association of Gap Healing With Angle of Correction After Opening-Wedge High Tibial Osteotomy Without Bone Grafting. Orthop J Sports Med. 2021;9(5):23259671211002289. doi: 10.1177/23259671211002289Park HJ, Kang SB, Chang MJ, Chang CB, Jung WH, Jin H. Association of Gap Healing With Angle of Correction After Opening-Wedge High Tibial Osteotomy Without Bone Grafting. Orthop J Sports Med. 2021;9(5):23259671211002289. doi: 10.1177/23259671211002289Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High Tibial Osteotomy: A Systematic Review and Current Concept. Arch Bone Jt Surg. 2016;4(3):204–12.Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High Tibial Osteotomy: A Systematic Review and Current Concept. Arch Bone Jt Surg. 2016;4(3):204–12.Jacobs CA, Christensen CP, Karthikeyan T. An Intact Anterior Cruciate Ligament at the Time of Posterior Cruciate Ligament-Retaining Total Knee Arthroplasty Was Associated With Reduced Patient Satisfaction and Inferior Pain and Stair Function. J Arthroplasty. 2016;31(8):1732–5. doi: 10.1016/j.arth.2016.01.026Jacobs CA, Christensen CP, Karthikeyan T. An Intact Anterior Cruciate Ligament at the Time of Posterior Cruciate LigamentRetaining Total Knee Arthroplasty Was Associated With Reduced Patient Satisfaction and Inferior Pain and Stair Function. J Arthroplasty. 2016;31(8):1732–5. doi: 10.1016/j.arth.2016.01.026He M, Zhong X, Li Z, Shen K, Zeng W. Progress in the treatment of knee osteoarthritis with high tibial osteotomy: a systematic review. Syst Rev. 2021;10(1):56. doi: 10.1186/s13643-021-01601-zHe M, Zhong X, Li Z, Shen K, Zeng W. Progress in the treatment of knee osteoarthritis with high tibial osteotomy: a systematic review. Syst Rev. 2021;10(1):56. doi: 10.1186/s13643-021-01601-zKim JH, Kim HJ, Lee DH. Leg length change after opening wedge and closing wedge high tibial osteotomy: A meta-analysis. PLoS One. 2017;12(7):e0181328. doi: 10.1371/journal.pone.0181328Kim JH, Kim HJ, Lee DH. Leg length change after opening wedge and closing wedge high tibial osteotomy: A meta-analysis. PLoS One. 2017;12(7):e0181328. doi: 10.1371/journal.pone.0181328Seo SS, Kim OG, Seo JH, Kim DH, Kim YG, Lee IS. Complications and Short-Term Outcomes of Medial Opening Wedge High Tibial Osteotomy Using a Locking Plate for Medial Osteoarthritis of the Knee. Knee Surg Relat Res. 2016;28(4):289–96. doi: 10.5792/ksrr.16.028Seo SS, Kim OG, Seo JH, Kim DH, Kim YG, Lee IS. Complications and Short-Term Outcomes of Medial Opening Wedge High Tibial Osteotomy Using a Locking Plate for Medial Osteoarthritis of the Knee. Knee Surg Relat Res. 2016;28(4):289–96. doi: 10.5792/ksrr.16.028Wade R, Shah S, Sujith BS, Shah K, Raj A, Marathe N. High tibial osteotomy in a lax knee: A review of current concepts. J Orthop. 2019;19:67–71. doi: 10.1016/j.jor.2019.10.023Wade R, Shah S, Sujith BS, Shah K, Raj A, Marathe N. High tibial osteotomy in a lax knee: A review of current concepts. J Orthop. 2019;19:67–71. doi: 10.1016/j.jor.2019.10.023Astur DC, Novaretti JV, Gomes ML, Rodrigues AGJr, Kaleka CC, Cavalcante ELB, Debieux P, Amaro JT, Cohen M. Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity. Orthop J Sports Med. 2020;8(4):2325967120913531. doi: 10.1177/2325967120913531Astur DC, Novaretti JV, Gomes ML, Rodrigues AGJr, Kaleka CC, Cavalcante ELB, Debieux P, Amaro JT, Cohen M. Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity. Orthop J Sports Med. 2020;8(4):2325967120913531. doi: 10.1177/2325967120913531Ollivier B, Berger P, Depuydt C, Vandenneucker H. Good longterm survival and patient-reported outcomes after high tibial osteotomy for medial compartment osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2021;29(11):3569–84. doi: 10.1007/s00167-020-06262-4Ollivier B, Berger P, Depuydt C, Vandenneucker H. Good longterm survival and patient-reported outcomes after high tibial osteotomy for medial compartment osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2021;29(11):3569–84. doi: 10.1007/s00167-020-06262-4Jin QH, Lee WG, Song EK, Jin C, Seon JK. Comparison of LongTerm Survival Analysis Between Open-Wedge High Tibial Osteotomy and Unicompartmental Knee Arthroplasty. J Arthroplasty. 2021;36(5):1562–7. doi: 10.1016/j.arth.2020.11.008Jin QH, Lee WG, Song EK, Jin C, Seon JK. Comparison of LongTerm Survival Analysis Between Open-Wedge High Tibial Osteotomy and Unicompartmental Knee Arthroplasty. J Arthroplasty. 2021;36(5):1562–7. doi: 10.1016/j.arth.2020.11.008Bouguennec N, Mergenthaler G, Gicquel T, Briand C, Nadau E, Pailhé R, Hanouz JL, Fayard JM, Rochcongar G; Francophone Arthroscopy Society. Medium-term survival and clinical and radiological results in high tibial osteotomy: Factors for failure and comparison with unicompartmental arthroplasty. Orthop Traumatol Surg Res. 2020;106(8S):S223–30. doi: 10.1016/j.otsr.2020.08.002Bouguennec N, Mergenthaler G, Gicquel T, Briand C, Nadau E, Pailhé R, Hanouz JL, Fayard JM, Rochcongar G; Francophone Arthroscopy Society. Medium-term survival and clinical and radiological results in high tibial osteotomy: Factors for failure and comparison with unicompartmental arthroplasty. Orthop Traumatol Surg Res. 2020;106(8S):S223–30. doi: 10.1016/j.otsr.2020.08.002

The authors declare that there are no conflicts of interest present.