胫骨结节下移术中规划的高准确性：术中测量与术后影像学结果的回顾性比较
简介
一项小样本回顾性研究纳入18例（22膝）行内侧髌股韧带重建联合胫骨结节远端移位截骨的髌股不稳患者，对比术中规划的Caton-Deschamps指数（CDI）降低值与术后实际矫正量。结果显示计划矫正量（0.35±0.11）与实际矫正量（0.34±0.13）高度一致（r=0.892，P=0.60），提示术中测量可准确预测术后CDI变化。该结果支持将CDI作为髌股…
英文摘要
PURPOSE: To evaluate the relation between intended intraoperative distalization and actual postoperative change in patellar height, as measured by the Caton-Deschamps Index (CDI). METHODS: A retrospective cohort undergoing medial patellofemoral ligament reconstruction with distalization tibial tubercle osteotomy was analyzed. Inclusion criteria consisted of subjects between the ages of 14 and 60 years who underwent medial patellofemoral ligament reconstruction with distalization tibial tubercle osteotomy, had been diagnosed with patellofemoral instability, and had perfect lateral radiographs. CDI was calculated pre- and postoperatively using standardized digital software. Two distalization techniques were used: (1) a distal oblique osteotomy using an anterior cruciate ligament saw blade with the autograft translated proximally and (2) a standard anteromedialization osteotomy with distalization achieved by inserting adjacent autograft bone proximally. Planned CDI change based on intraoperative measurements was compared with actual CDI change using Pearson correlation, linear regression, paired t-tests, and Bland-Altman analysis. RESULTS: The final cohort consisted of 22 knees in 18 patients (mean age 22.2 ± 8.1 years). Preoperative CDI averaged 1.42 ± 0.15 and postoperative CDI 1.07 ± 0.11. The planned CDI reduction was 0.35 ± 0.11, and the achieved change was 0.34 ± 0.13. Pearson correlation revealed r = 0.892. Linear regression showed R2 = 0.795 with a slope of 0.981. Paired t-test showed no significant difference between planned and actual CDI change (P = .60). Bland-Altman analysis indicated mean bias of -0.006 with 95% limits of agreement from -0.118 to +0.105. CONCLUSIONS: Intraoperative planning for distalization tibial tubercle osteotomy translates into accurate postoperative correction of patellar height with minimal bias. These findings support the reliability of intraoperative measurement in achieving radiographic goals and reinforce the use of CDI as a practical metric for surgical planning in patellfemoral instability. LEVEL OF EVIDENCE: Level IV, retrospective case series.