臨床整形外科56巻9号

2021年09月発行

特集 膝周囲骨切り術を成功に導く基礎知識

最新の知見に基づいた膝周囲骨切り術の適応とタイミング

著者： 秋山武徳¹

所属機関： ¹医療法人秋山クリニック

ページ範囲：P.1125 - P.1130

　膝周囲骨切り術(AKO)では，患側コンパートメント以外にはOAがなく，関節温存を強く望む，比較的若く，活動的な変形性膝関節症(膝OA)患者が基本的な適応となる．生理的な関節面傾斜を目指して，脛骨のみならず大腿骨をも含む膝周囲の変形中心に骨切りが行われるため，変形中心や患者特性による多種多様の術式が選択でき，その適応はより複雑化している．アライメント異常と半月板逸脱があり，痛みと10mL以上の水腫が続く症例では，より早期膝OAのタイミングでAKOが適応と考えられるようになった．

参考文献

1) Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg Am 1973;55(1):23-48.

2) Staubli AE, De Simoni C, Babst R, et al. TomoFix:A new LCP-concept for open wedge osteotomy of the medial proximal tibia--early results in 92 cases. Injury 2003;34 suppl 2:B55-62.

3) Bonasia DE, Dettoni F, Sito G, et al. Medial opening wedge high tibial osteotomy for medial compartment overload arthritis in the varus knee:prognostic factors. Am J Sports Med;2014;42(3):690-8.

4) Trieb K, Grohs J, Hanslik-Schnabel B, et al. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2006;14(2):149-52.

5) Goshima K, Sawaguchi t, Sakagoshi D, et al. Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy. Knee surg sports traumatol Arthrosc 2017;25(3):918-23.

6) Song JH, Bin SI, Kim JM, et al. Cartilage status, rather than chronologic age, determines the outcomes of open wedge high tibial osteotomy:a cartilage status-matched cohort study. Arthroscopy 2021;S0749-8063(21)00341-8.

7) Howells NR, Salmon L, Waller A, et al. The outcome at ten years of lateral closing-wedge high tibial osteotomy:determinants of survival and functional outcome. Bone Joint J 2014;96-B(11):1491-7.

8) Akizuki S, Shibakawa A, Takizawa T, et al. The long-term outcome of high tibial osteotomy:a ten- to 20-year follow-up. J Bone Joint Surg Br 2008;90(5):592-6.

9) Sohn S, Koh IJ, Kim MS, et al. What factors predict patient dissatisfaction after contemporary medial opening-wedge hightibial osteotomy? J Arthroplasty 2020;35(2):318-24.

10) Nha KW, Oh SM, Ha YW, et al. Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2019;27(6):2021-9.

11) Lee BS, Kim TA, Bin SI, et al. Clinicoradiologic outcomes of medial open-wedge high-tibial osteotomy are equivalent in bone-on-bone and none-bone-on-bone medial osteoarthritis. Arthroscopy 2021;37(2);638-44.

12) Goshima K, Sawaguchi T, Shigemoto K, et al. Patellofemoral osteoarthritis progression and alignment changes after open-wedge high tibial osteotomy do not affect clinical outcomes at mid-term follow-up. Arthroscopy 2017;33(10):1832-9.

13) Gaasbeek RD, Sonneveld H, van Heerwaarden RJ, et al. Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera:a new technique. Knee 2004;11(6):457-61.

14) Akiyama T, Osano K, Mizu-Uchi H, et al. Distal Tibial Tuberosity Arc Osteotomy in Open-Wedge Proximal Tibial Osteotomy to Prevent Patella Infra. Arthrosc Tech 2019;8(6):e655-e662.

15) Takeuchi R, Ishikawa H, Miyasaka Y, et al. A novel closed-wedge high tibial osteotomy procedure to treat osteoarthritis of the knee:hybrid technique and rehabilitation measures. Arthrosc Tech 2014;3(4):e431-7.

16) Kondo E, Yasuda K, Yabuuchi K, et al. Inverted V-shaped high tibial osteotomy for medial osteoarthritic knees with severe varus deformity arthrosc tech 2018;7(10):e999-e1012.

17) Okazaki K. Interlocking closed-wedge high tibial osteotomy modified with oblique osteotomy lines and a locking plate fixation. Arthrosc Tech 2021;10(4):e1061-e1066.

18) Nakayama H, Iseki T, Kanto R, et al. Physiologic knee joint alignment and orientation can be restored by the minimally invasive double level osteotomy for osteoarthritic knees with severe varus deformity. Knee Surg Sports Traumatol Arthrosc 2020;28(3):742-50.

19) Forkel P, Achtnich A, Metzlaff S, et al. Midterm results following medial closed wedge distal femoral osteotomy stabilized with a locking internal fixation device. Knee Surg Sports Traumatol Arthrosc 2015;23(7):2061-7.

20) Puddu G, Cipolla M, Cerullo G, et al. Which osteotomy for a valgus knee? Int Orthop 2010;34(2):239-47.

21) Sherman SL, Thompson SF, Clohisy JCF. Distal femoral varus osteotomy for the management of valgus deformity of the knee. J Am Acad Orthop Surg 2018;26(9):313-24.

22) Goto N, Okazaki K, Akiyama T, et al. Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development. Knee Surg Sports Traumatol Arthrosc 2019;27(8):2617-23.