胫骨结节远端高位截骨术中MPTA与WBLR的相关性分析

摘要
图/表
参考文献
相关文章 (2)

全文: PDF (5656 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨胫骨结节远端高位截骨术(distal tibial tuberosity high tibial osteotomy，DTT-HTO)中胫骨近端内侧角(medial proximal tibia angle，MPTA)与下肢力线比率(weightbearing line ratio，WBLR)的相关性，为手术提供依据。方法选取2019年10月至2021年10月在北京中医药大学第三附属医院微创关节科行DTT-HTO治疗的26例(28膝)患者，其中男4例，女22例；左膝9个，右膝19个；年龄50~81岁，平均年龄(65.68±6.53)岁。所有患者均完成手术并随访，期间无不良事件发生。采用MPTA和WBLR评估手术前后下肢力学状态的变化；并计算手术前后MPTA和WBLR的改变值，采用美国特种外科医院(the hospital special surgery，HSS)评分评估手术前后膝关节功能，并计算手术前后HSS的改变值。本研究将WBLR设置在50%~70%的良好位置，采用SPSS 25.0软件进行数据分析。绘制受试者工作特征(receiveroperating characteristic，ROC)曲线，得到曲线下面积(area under the curve，AUC)，分别计算50%和70%WBLR对应的MPTA临界值。根据两个临界值将患者分为矫正不足组、矫正适当组和矫正过度组，比较三组患者术前基线信息，术前、术后WBLR、MPTA、HSS和手术前后的改变值。用SPSS 25.0软件绘制术前、术后和手术前后改变值WBLR和MPTA的相关性分析散点图。结果术后WBLR、MPTA、HSS与术前比较均有明显变化，差异有统计学意义(P＞0.01)。无论术前、术后或手术前后改变值，MPTA均与WBLR相关，AUC均大于0.5。计算得出，50%和70% WBLR对应的MPTA的临界值分别为90.5 °和93.5 °，50%和70% WBLR对应的MPTA改变值的临界值分别为6.5 °和9.5 °。三组术前基线信息差异无统计学意义；术前MPTA、术后MPTA改变值、术后MPTA、术后WBLR、术后HSS和术后WBLR改变值在三组间比较差异有统计学意义，并根据阳性结果进行组间两两比较。结论 MPTA对膝骨关节炎有一定的诊断价值。作为一种简单省时的单关节测量方法，建议将MPTA应用于C型臂膝关节术中图像，并作为除下肢力线外HTO测量的参考值，以达到术中测量准确、方便的要求。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	丁天送
	田向东
	谭冶彤
	薛志鹏
	马晟
	胡元一
	李晓敏
	尹岳桐

关键词 ：胫骨结节远端高位截骨术, 相关性分析, 下肢力线比, 胫骨近端内侧角

Abstract：

Objective To explore the correlation between medial proximal tibia angle (MPTA) and weightbearing line ratio (WBLR) in the distal tibial tuberosity high tibial osteotomy (DTT-HTO).Methods A total of 26 patients (28 knees) who received DTT-HTO treatment in Minimal Invasive Joint Surgery Department of the Third Affiliated Hospital of Beijing University of Chinese Medicine from October 2019 to October 2021 were selected，including 4 males and 22 females，9 left knees and 19 right knees.The age distribution ranged from 50 to 81 years old with an average age of (65.68±6.53)years old.All patients underwent surgery and were followed up.MPTA and WBLR were used to evaluate the changes of lower limb mechanical status before and after surgery.The changes in MPTA and WBLR before and after surgery were calculated.Knee function before and after surgery was evaluated by the hospital special surgery (HSS)，and the changes in HSS before and after surgery were calculated.In this study，WBLR was set at a good position of 50% ~ 70%，and SPSS 25.0 software was used for data analysis.Receiver operating characteristic (ROC) curve was plotted to obtain the area under the curve (AUC)，and MPTA critical values corresponding to 50% and 70% WBLR were calculated，respectively.Patients were divided into under-corrected group，appropriate corrected group and over-corrected group according to two critical values.Preoperative baseline information，preoperative and postoperative WBLR，MPTA，HSS，and changes before and after surgery were compared among the three groups.SPSS 25.0 software was used to draw the correlation analysis scatter plots of WBLR and MPTA before and after surgery.Results Postoperative WBLR，MPTA and HSS were significantly different from those before surgery，and the differences were statistically significant (P＜0.01).MPTA was correlated with WBLR regardless of preoperative，postoperative or change value.AUC were all greater than 0.5.The critical values of MPTA for 50% WBLR and 70% WBLR are 90.5 ° and 93.5 °，respectively，and the critical values for MPTA changes for 50% WBLR and 70% WBLR were 6.5 ° and 9.5 °，respectively.There was no significant difference in preoperative baseline information among the three groups.Preoperative MPTA，postoperative MPTA changes，postoperative MPTA，postoperative WBLR，postoperative HSS and postoperative WBLR changes showed statistically significant differences among the three groups，and pairwise comparison was conducted based on the positive results.Conclusion MPTA has certain diagnostic value for KOA.As a simple and time saving single joint measurement method，MPTA is recommended to be applied to the knee joint intraoperative image of C arm and as a reference value for HTO measurement except the lower limb force line，so as to achieve accurate and convenient intraoperative measurement requirements.

Key words： distal tibial tuberosity high tibial osteotomy correlation analysis weight-bearing line ratio medial proximal tibia angle

基金资助:北京中医药大学重点攻关项目(2020-JYB-ZDGG-142-5)

通讯作者: 田向东

作者简介: 丁天送(1996－ )，女，研究生在读，北京中医药大学，dts961025@163.com

引用本文:

丁天送，田向东，谭冶彤，薛志鹏，马晟，胡元一，李晓敏，尹岳桐. 胫骨结节远端高位截骨术中MPTA与WBLR的相关性分析[J]. 实用骨科杂志, 2023, 29(5): 405-.
Ding Tiansong，Tian Xiangdong，Tan Yetong，Xue Zhipeng，Ma Sheng，Hu Yuanyi，Li Xiaomin，Yin Yuetong. Dependence Analysis Between MPTA and WBLR in the Distal Tibial Tuberosity High Tibial Osteotomy. sygkzz, 2023, 29(5): 405-.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I5/405

［1］Ding T，Tan Y，Tian X，et al.Patellar height after high tibial osteotomy of the distal tibial tuberosity：A retrospective study of age stratification［J］.Comput Math Methods Med，2022(2018)：7193902.
［2］Biehl M，Damm P，Trepczynski A，et al.Towards planning of osteotomy around the knee with quantitative inclusion of the adduction moment：A biomechanical approach［J］.J Exp Orthop，2021，8(1)：39.
［3］Fujisawa Y，Masuhara K，Shiomi S.The effect of high tibial osteotomy on osteoarthritis of the knee.An arthroscopic study of 54 knee joints［J］.Orthop Clin North Am，1979，10(3)：585-608.
［4］Hernigou P，Medevielle D，Debeyre J，et al.Proximal tibial osteotomy for osteoarthritis with varus deformity.A ten to thirteen-year follow-up study［J］.J Bone Joint Surg (Am)，1987，69(3)：332-354.
［5］Yin Y，Li S，Zhang R，et al.What is the relationship between the “Fujisawa point” and postoperative knee valgus angle?A theoretical，computer-based study［J］.Knee，2020，27(1)：183-191.
［6］Yang JC，Chen CF，Luo CA，et al.Clinical experience using a 3D-printed patient-specific instrument for medial opening wedge high tibial osteotomy［J］.Biomed Res Int，2018(2018)：9246529.
［7］Sabzevari S，Ebrahimpour A，Roudi MK，et al.High tibial osteotomy：A systematic review and current concept［J］.Arch Bone Jt Surg，2016，4(3)：204-212.
［8］Reising K，Strohm PC，Hauschild O，et al.Computer-assisted navigation for the intraoperative assessment of lower limb alignment in high tibial osteotomy can avoid outliers compared with the conventional technique［J］.Knee Surg Sports Traumatol Arthrosc，2013，21(1)：181-188.
［9］Niemeyer P，Koestler W，Kaehny C，et al.Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee［J］.Arthroscopy，2008，24(7)：796-804.
［10］Niemeyer P，Schmal H，Hauschild O，et al.Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment：3year results with regard to preoperative arthroscopic and radiographic findings［J］.Arthroscopy，2010，26(12)：1607-1616.
［11］Ishimatsu T，Takeuchi R，Ishikawa H，et al.Femoral morphology affects postoperative alignment of the lower extremities in hybrid closed-wedge high tibial osteotomy［J］.Arch Orthop Trauma Surg，2022，142(12)：3675-3685.
［12］Trieb K，Grohs J，HanslikSchnabel B，et al.Age predicts outcome of high-tibial osteotomy［J］.Knee Surg Sports Traumatol Arthrosc，2006，14(2)：149-152.
［13］Tuhanioglu ，Ogur HU，Seyfettinoglu F，et al.High tibial osteotomy in obese patients：Is successful surgery enough for a good outcome?［J］.J Clin Orthop Trauma，2019，10(Suppl 1)：S168-S173.
［14］Yoon JR，Ko SN，Jung KY，et al.Risk of revision following total knee arthroplasty or high tibial osteotomy：A nationwide propensity-score-matched study［J］.J Bone Joint Surg (Am)，2019，101(9)：771-778.
［15］Kettelkamp DB，Wenger DR，Chao EY，et al.Results of proximal tibial osteotomy.The effects of tibiofemoral angle，stance-phase flexion-extension，and medial-plateau force［J］.J Bone Joint Surg (Am)，1976，58(7)：952-960.
［16］Koshino T，Yoshida T，Ara Y，et al.Fifteen to twenty-eight years' follow-up results of high tibial valgus osteotomy for osteoarthritic knee［J］.Knee，2004，11(6)：439-444.
［17］Benzakour T，Hefti A，Lemseffer M，et al.High tibial osteotomy for medial osteoarthritis of the knee：15 years follow-up［J］.Int Orthop，2010，34(2)：209-215.
［18］Lootvoet L，Massinon A，Rossillon R，et al.Upper tibial osteotomy for gonarthrosis in genu varum.Apropos of a series of 193 cases reviewed 6 to 10 years later［J］.Rev Chir Orthop Reparatrice Appar Mot，1993，79(5)：375-384.
［19］Goutallier D，Hernigou P，Medevielle D，et al.Outcome at more than 10 years of 93 tibial osteotomies for internal arthritis in genu varum (or the predominant influence of the frontal angular correction)［J］.Rev Chir Orthop Reparatrice Appar Mot，1986，72(2)：101-113.
［20］Lee YS，Kim MK，Byun HW，et al.Reliability of the imaging software in the preoperative planning of the open-wedge high tibial osteotomy［J］.Knee Surg Sports Traumatol Arthrosc，2015，23(3)：846-851.
［21］Agneskirchner JD，Hurschler C，Wrann CD，et al.The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee：A biomechanical study［J］.Arthroscopy，2007，23(8)：852-861.
［22］Maeda S，Chiba D，Sasaki E，et al.The difficulty of continuing sports activities after open-wedge high tibial osteotomy in patient with medial knee osteoarthritis：A retrospective case series at 2-year-minimum follow-up［J］.J Exp Orthop，2021，8(1)：68.
［23］Felson DT，Niu J，Gross KD，et al.Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression：Findings from the multicenter osteoarthritis study and the osteoarthritis initiative［J］.Arthritis Rheum，2013，65(2)：355-362.
［24］Schr-ter S，Nakayama H，Yoshiya S，et al.Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line［J］.Arch Orthop Trauma Surg，2019，139(4)：519-527.
［25］Goshima K.Editorial commentary：Early postoperative knee joint space width change is attributable to change in the joint line convergence angle after high tibial osteotomy and may not reflect cartilage regeneration［J］.Arthroscopy，2021，37(11)：3324-3325.
［26］Martay JL，Palmer AJ，Bangerter NK，et al.A preliminary modeling investigation into the safe correction zone for high tibial osteotomy［J］.Knee，2018，25(2)：286-295.
［27］Miniaci A，Ballmer FT，Ballmer PM，et al.Proximal tibial osteotomy.A new fixation device［J］.Clin Orthop Relat Res，1989(246)：250-259.
［28］Sohn S，Koh IJ，Kim MS，et al.Risk factors and preventive strategy for excessive coronal inclination of tibial plateau following medial opening-wedge high tibial osteotomy［J］.Arch Orthop Trauma Surg，2022，142(4)：561-569.
［29］Akamatsu Y，Kumagai K，Kobayashi H，et al.Effect of increased coronal inclination of the tibial plateau after opening-wedge high tibial osteotomy［J］.Arthroscopy，2018，34(7)：2158-2169；2152.
［30］Nakayama H，Schr-ter S，Yamamoto C，et al.Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage［J］.Knee Surg Sports Traumatol Arthrosc，2018，26(6)：1873-1878.
［31］Chao EY，Neluheni EV，Hsu RW，et al.Biomechanics of malalignment［J］.Orthop Clin North Am，1994，25(3)：379-386.
［32］Mullaji A，Bhoskar R，Singh A，et al.Valgus arthritic knees can be classified into nine phenotypes［J］.Knee Surg Sports Traumatol Arthrosc，2022，30(9)：2895-2904.
［33］Boettner F，Renner L，Arana Narbarte D，et al.Total knee arthroplasty for valgus osteoarthritis：The results of a standardized soft-tissue release technique［J］.Knee Surg Sports Traumatol Arthrosc，2016，24(8)：2525-2531.
［34］Pornrattanamaneewong C，Narkbunnam R，Chareancholvanich K.Medial proximal tibial angle after medial opening wedge HTO：A retrospective diagnostic test study［J］.Indian J Orthop，2012，46(5)：525-530.