Sydney Orthopaedic Research Institute, Level 1, The Gallery 445 Victoria Avenue, Chatswood, NSW, 2067, Australia.
Knee Surg Sports Traumatol Arthrosc. 2013 Jan;21(1):32-8. doi: 10.1007/s00167-012-2229-6. Epub 2012 Oct 4.
In contrast to radiographic measurements, MRI provides multiple slices of the knee joint in the sagittal plane, making it possible to assess the medial and lateral tibial slope separately. The purpose of this study is to investigate the effect of medial open-wedge high tibial osteotomy (MOWHTO) on bony and meniscal slope in the medial and lateral tibiofemoral compartments. It was hypothesised that greater changes on the medial tibial plateau would be observed compared with the lateral one.
A retrospective analysis of prospectively collected data was performed on pre- and post-operative MRIs from 21 patients (17 men and 4 women; age 52 ± 9 years). Inclusion criteria were varus alignment, medial compartment osteoarthritis and election for a primary MOWHTO. Each patient had a preoperative and a post-operative high-resolution MRI (3Tesla, Magnetom Trio, Siemens AG) at an average follow-up of 2.1 years. A previously published method was used to measure bony and meniscal slope for each compartment. The difference between pre- and post-operative tibial slope for both compartments was calculated and associated with the amount of frontal correction.
There was a significant increase in bony tibial slope in both compartments following MOWHTO. When a change in bony tibial slope was detected in an individual patient, the change was larger in the medial compartment, with the average change also significantly greater (p < 0.01) in the medial compartment (2.4° ± 1.3°) compared with the lateral compartment (0.9° ± 1.1°). There was also a significant increase (p < 0.01) in the lateral tibial meniscal slope of 0.9° ± 1.4°, which was equivalent to the change in the bony lateral slope. The amount of frontal correction was not significantly associated with the amount of change in slope.
The results suggest that the modification of the bony slope is larger in the medial compartment after MOWHTO, which is likely related to the location of the hinge on the lateral tibial cortex. These findings suggest that consideration of the medial and lateral tibial slope intra-operatively could be important to identify the optimal location of the hinge. However, further studies are required before recommending any modification to the surgical technique, as the potential clinical consequences of tibial slope alterations remain unknown.
IV.
与放射影像学测量相比，MRI 可提供矢状位膝关节的多个切片，从而能够分别评估胫骨内侧和外侧倾斜度。本研究的目的是探讨内侧开放楔形胫骨高位截骨术（MOWHTO）对胫骨股骨内侧和外侧间室的骨和半月板倾斜度的影响。假设内侧胫骨平台的变化将大于外侧。
对 21 名患者（17 名男性和 4 名女性；年龄 52 ± 9 岁）的前瞻性收集数据进行回顾性分析。纳入标准为内翻畸形、内侧间室骨关节炎和选择初次 MOWHTO。每位患者均在平均 2.1 年的随访中接受术前和术后高分辨率 MRI（3Tesla，Magnetom Trio，Siemens AG）。使用先前发表的方法测量每个间室的骨和半月板倾斜度。计算两个间室的胫骨斜率术前和术后的差值，并与额状面校正量相关联。
MOWHTO 后，两个间室的胫骨斜率均显著增加。当个体患者检测到胫骨斜率的变化时，内侧间室的变化更大，平均变化也显著更大（p < 0.01），为 2.4°±1.3°，而外侧间室为 0.9°±1.1°。外侧胫骨半月板斜率也显著增加（p < 0.01），为 0.9°±1.4°，与骨外侧斜率的变化相当。额状面校正量与斜率变化量无显著相关性。
结果表明，MOWHTO 后内侧间室的骨斜率变化较大，这可能与外侧胫骨皮质上铰链的位置有关。这些发现表明，术中考虑内侧和外侧胫骨斜率可能很重要，以确定铰链的最佳位置。然而，在推荐对手术技术进行任何修改之前，还需要进一步的研究，因为胫骨斜率改变的潜在临床后果尚不清楚。
IV。
