Issın Ahmet, Sahin Vedat, Koçkara Nizamettin, Gürsu Sükrü Sarper, Kurtuldu Ali, Yıldırım Timur
Department of Orthopedics and Traumatology, Metin Sabancı Bone Diseases Training and Research Hospital, 34470 Baltalimanı, İstanbul, Turkey.
Eklem Hastalik Cerrahisi. 2012;23(3):128-33.
In this study, we aimed to evaluate the components of knee varus in the adjacent joints and to investigate the possible correlations between them.
Between January 2005 and December 2010, 315 lower limbs of 164 patients who underwent high tibial osteotomy (HTO) due to varus gonarthrosis were analyzed. Alignment and orientation angles of these limbs using preoperative orthoroentgenography were measured. The results were compared with normal values and evaluated statistically for possible correlations.
Statistical analysis of the data showed that the mean value of mechanical lateral distal femoral angle (mLDFA) increases in varus knees and thus distal femoral joint orientation showed less valgus. The effect of mLDFA on mechanical tibiofemoral angle (mTFA) was almost the same as medial proximal tibial angle (MPTA). Both together; they explain 52.2% of variance in mTFA. mLDFA has a negative and MPTA has a positive and significant influence on mTFA (b= -0.765, p<0.001) and (b= 0.798, p<0.001) respectively. A moderate correlation was found between the mTFA and lateral distal tibial angle (LDTA) in the lower limbs grounding at the same angle (r=0.634, R=0.40, p<0.001). A slight, but significant correlation between mTFA and medial neck shaft angle (MNSA) was found (r=0.15, R=0.02, p<0.01).
Distal femoral joint showing less valgus significantly contributes to the deformity in varus gonarthrosis, also a very important contributor to the deformity. Abnormal forces applied to ankle may cause collapse in distal lateral tibial metaphysis and decrease LDTA in varus knees. Medial neck shaft angle may decrease due to possible abnormal loading angles to the femoral neck in some individuals with varus gonarthrosis.
在本研究中，我们旨在评估膝关节内翻在相邻关节中的组成部分，并研究它们之间可能的相关性。
2005年1月至2010年12月期间，对164例因膝内翻性膝关节炎接受高位胫骨截骨术（HTO）的患者的315条下肢进行了分析。使用术前正位X线片测量这些下肢的对线和定向角度。将结果与正常值进行比较，并对可能的相关性进行统计学评估。
数据的统计分析表明，膝内翻膝关节的机械性股骨远端外侧角（mLDFA）平均值增加，因此股骨远端关节定向显示外翻减少。mLDFA对机械性胫股角（mTFA）的影响与胫骨近端内侧角（MPTA）几乎相同。两者共同作用；它们解释了mTFA中52.2%的方差。mLDFA对mTFA有负向且显著的影响（b = -0.765，p < 0.001），MPTA对mTFA有正向且显著的影响（b = 0.798，p < 0.001）。在以相同角度着地的下肢中，mTFA与胫骨远端外侧角（LDTA）之间发现中度相关性（r = 0.634，R = 0.40，p < 0.001）。mTFA与股骨内侧颈干角（MNSA）之间发现轻微但显著相关性（r = 0.15，R = 0.02，p < 0.01）。
股骨远端关节外翻减少显著导致膝内翻性膝关节炎的畸形，也是畸形的一个非常重要的因素。施加于踝关节的异常力可能导致膝内翻膝关节的胫骨远端外侧干骺端塌陷并降低LDTA。在一些膝内翻性膝关节炎患者中，由于股骨颈可能存在异常负荷角度，股骨内侧颈干角可能减小。
