Weidenhielm L, Svensson O K, Broström L Å
Department of Orthopedics, St Görans Hospital, Karolinska Institute, Sweden.
Clin Biomech (Bristol). 1992 Aug;7(3):177-80. doi: 10.1016/0268-0033(92)90033-Z.
The purpose of this study was to investigate the change of load about the knee joint and the ipsilateral hip and ankle joints in the coronal plane after high tibial valgus osteotomy in nine patients, mean age 64 years, mean weight 81 kg, with moderate medial osteoarthrosis of the knee, compared to ten age-matched normal controls. Moments about the joints were assessed with a computerized Kistler force platform and a videorecording system before surgery, and 6 and 12 months after surgery. Loads in the joints are related to the peak and midstance external adduction moments and the area under the moment curve. In patients before surgery there was a significantly increased adduction moment in both the hip and knee joints compared to the normal controls. After surgery the adduction moment was reduced to subnormal levels in the knee and normal levels in the hip joint. The moments about the ankle joint were unaffected both by the knee deformity and by the corrective surgery. This study demonstrates that a varus malalignment in the osteoarthrotic knee is accompanied by increased load about the ipsilateral hip. We do not know if this increased load about the hip has any pathological significance, but one might suspect a more rapid progression of degenerative changes in the hip joint cartilage as a consequence of the increased load. We have also found that the frontal plane moment about the hip can be reduced to a normal level when the knee is changed into slight valgus. The reduced load might be beneficial to a patient with osteoarthrosis of the ipsilateral hip and knee.
本研究旨在调查9例平均年龄64岁、平均体重81kg、患有中度膝关节内侧骨关节炎的患者，在进行胫骨高位外翻截骨术后，膝关节以及同侧髋关节和踝关节在冠状面的负荷变化，并与10例年龄匹配的正常对照者进行比较。在手术前、术后6个月和12个月，使用计算机化的奇石乐测力平台和视频记录系统评估关节力矩。关节负荷与峰值和站立中期的外展力矩以及力矩曲线下的面积相关。与正常对照者相比，术前患者的髋关节和膝关节内收力矩均显著增加。术后，膝关节内收力矩降至低于正常水平，而髋关节内收力矩降至正常水平。踝关节力矩不受膝关节畸形和矫正手术的影响。本研究表明，骨关节炎膝关节的内翻畸形伴有同侧髋关节负荷增加。我们不知道这种髋关节负荷增加是否具有任何病理意义，但有人可能会怀疑，由于负荷增加，髋关节软骨退变变化可能会更快进展。我们还发现，当膝关节变为轻度外翻时，髋关节在额状面的力矩可降至正常水平。负荷降低可能对患有同侧髋膝关节骨关节炎的患者有益。
