Weidenhielm L, Svensson O K, Broström L Å, Rudberg U
Department of Orthopaedic Surgery, St Görans Hospital, Department of Anatomy and Physical Medicine and Rehabilitation, Karolinska Institute, Sweden.
Clin Biomech (Bristol). 1992 May;7(2):91-6. doi: 10.1016/0268-0033(92)90021-U.
Fifty-three patients with moderate medial osteoarthrosis of the knee were studied before and after corrective surgery. Twenty-five patients were treated with high tibial osteotomy and 28 with unicompartmental prosthetic replacement (Brigham model). The external moments about the knee were calculated and correlated to the hip-knee-ankle angles before and 1 year after corrective surgery. The hip-knee-ankle angle was determined from whole-leg weightbearing radiographs before and 1 year after surgery. The peak adduction moment and' the mid-stance adduction moment about the knee in the coronal plane during gait were determined with a Kistler force plate and a videorecording system. Surgical correction of leg alignment measured with the hip-knee-ankle angles were achieved in both groups. After surgery the mean hip-knee-ankle angle was changed from 9° of varus to 3° of varus in the prosthetic group and from 9° of varus to 4° of valgus in the osteotomy group. The mean peak knee adduction moment was reduced from 66 N m to 47 N m in the prosthetic group (P < 0.01) and from 63 N m to 21 N m in the osteotomy group (P < 0.001). The' mean mid-stance knee adduction moment was reduced from 48 N m to 27 N m in the prosthetic group (P < 0.001) and from 47 N m to 13 N m in the osteotomy group (P < 0.001). There was an association between the change in adduction moments about the knee and the change in hip-knee-ankle angle after surgery (r = 0.45, P < 0.001). In conclusion our results show that correction of leg aligment will reduce the adduction moments about the osteoarthrotic knee during gait.
对53例膝关节中度内侧骨关节炎患者在矫正手术前后进行了研究。25例患者接受了高位胫骨截骨术，28例接受了单髁假体置换术（布里格姆模型）。计算了膝关节的外力矩，并将其与矫正手术前和术后1年的髋-膝-踝角度相关联。髋-膝-踝角度通过术前和术后1年的全腿负重X线片确定。使用奇石乐测力板和视频记录系统测定步态期间冠状面膝关节的峰值内收力矩和站立中期内收力矩。两组均通过髋-膝-踝角度测量实现了下肢力线的手术矫正。术后，假体组的平均髋-膝-踝角度从内翻9°变为内翻3°，截骨组从内翻9°变为外翻4°。假体组的平均膝关节峰值内收力矩从66 N·m降至47 N·m（P<0.01），截骨组从63 N·m降至21 N·m（P<0.001）。假体组的平均站立中期膝关节内收力矩从48 N·m降至27 N·m（P<0.001），截骨组从47 N·m降至13 N·m（P<0.001）。术后膝关节内收力矩的变化与髋-膝-踝角度的变化之间存在关联（r=0.45，P<0.001）。总之，我们的结果表明，矫正下肢力线将减少骨关节炎膝关节在步态期间的内收力矩。
