Mucha Armin, Dordevic Milos, Hirschmann Anna, Rasch Helmut, Amsler Felix, Arnold Markus P, Hirschmann Michael T
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
Department of Radiology, University Hospital Basel, Basel, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2015 Aug;23(8):2315-2323. doi: 10.1007/s00167-014-3053-y. Epub 2014 May 11.
The purpose was to prospectively evaluate the outcome, in particular the SPECT/CT bone tracer uptake (BTU) after high tibial osteotomy (HTO) due to symptomatic varus malalignment. It was the hypothesis that the BTU after HTO decreases in the medial compartment, clinical outcome and the degree of correction correlates with BTU and asymptomatic patients after HTO reveals a significantly decreased BTU in the medial subchondral areas.
Twenty-two consecutive patients with 23 knees undergoing medial opening-wedge HTO for medial compartment overloading were assessed pre- and postoperatively (12 and/or 24 months) using Tc-99m-HDP-SPECT/CT including our 4D-SPECT/CT protocol. BTU was quantified and localized to specific biomechanically relevant joint areas. Maximum absolute and relative values (mean ± standard deviation, median and range) for each area were recorded. Pre- and postoperative mechanical alignment was measured. At 24 months after HTO, the WOMAC score was used.
A significant decrease of BTU in the medial subchondral zones after HTO was found (preoperatively to 12 and 24 months postoperatively, p < 0.01). BTU normalized in all asymptomatic patients within 24 months. This decrease was partly seen in the lateral compartments, but significantly higher in the medial compartments (p < 0.0001). A significant increase of the BTU was noted in zones directly adjacent to the plate or within the osteotomy zone (p < 0.01). Decreased BTU was observed in osteotomy zones at 24 months postoperatively following higher uptake values at 12 months postoperatively. The average valgus correction of the tibiofemoral angle was 5.9° ± 2.8°. Less stiffness correlated significantly with a higher decrease in BTU (p < 0.05). Higher postoperative BTU significantly correlated with more pain (p < 0.05). No statistical significant associations between BTU and alignment correction were found.
In patients with medial compartment, overloading due to varus malalignment HTO led to a significant decrease in BTU in the medial joint compartments. SPECT/CT BTU patterns and intensity in these patients pre- to 12 and 24 months postoperatively were seen. These correlated significantly with pain and stiffness. Hence, SPECT/CT could be used for assessment of adequate correction and healing after HTO. SPECT/CT could be further used to identify the optimal individualized correction for each patient and clinical scenario.
Diagnostic prospective study, Level II.
本研究旨在前瞻性评估因症状性内翻畸形行高位胫骨截骨术（HTO）后的结果，尤其是SPECT/CT骨显像剂摄取（BTU）情况。研究假设为，HTO术后内侧间室的BTU降低，临床结果和矫正程度与BTU相关，且HTO术后无症状患者内侧软骨下区域的BTU显著降低。
连续纳入22例患者的23个膝关节，这些患者因内侧间室负荷过重接受内侧开放楔形HTO手术，术前及术后（12个月和/或24个月）采用Tc-99m-HDP-SPECT/CT进行评估，包括我们的4D-SPECT/CT方案。对BTU进行定量并定位到特定的生物力学相关关节区域。记录每个区域的最大绝对值和相对值（平均值±标准差、中位数和范围）。测量术前及术后的机械对线情况。在HTO术后24个月，使用WOMAC评分。
发现HTO术后内侧软骨下区域的BTU显著降低（术前至术后12个月和24个月，p<0.01）。所有无症状患者在24个月内BTU恢复正常。这种降低部分见于外侧间室，但在内侧间室更为显著（p<0.0001）。在与钢板直接相邻的区域或截骨区内，BTU显著增加（p<0.01）。术后24个月截骨区的BTU较术后12个月摄取值升高后有所降低。胫股角的平均外翻矫正为5.9°±2.8°。僵硬程度减轻与BTU更高的降低显著相关（p<0.05）。术后BTU越高与疼痛越明显显著相关（p<0.05）。未发现BTU与对线矫正之间存在统计学显著关联。
在内侧间室因内翻畸形负荷过重的患者中，HTO导致内侧关节间室的BTU显著降低。观察到这些患者术前至术后12个月和24个月的SPECT/CT BTU模式和强度。这些与疼痛和僵硬显著相关。因此，SPECT/CT可用于评估HTO后的充分矫正和愈合情况。SPECT/CT可进一步用于确定针对每个患者和临床情况的最佳个体化矫正方案。
诊断性前瞻性研究，二级。
