膝关节软组织松弛对开放性楔形高位胫骨截骨术中肢体对线矫正的影响。
Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy.
作者信息
Lee Dae-Hee, Park Sung-Chul, Park Hyung-Joon, Han Seung-Beom
机构信息
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Anam Hospital, Korea University School of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2016 Dec;24(12):3704-3712. doi: 10.1007/s00167-015-3682-9. Epub 2015 Jul 8.
PURPOSE
Open-wedge high tibial osteotomy (HTO) cannot always accurately correct limb alignment, resulting in under- or over-correction. This study assessed the relationship between soft tissue laxity of the knee joint and alignment correction in open-wedge HTO.
METHODS
This prospective study involved 85 patients (86 knees) undergoing open-wedge HTO for primary medial osteoarthritis. The mechanical axis (MA), weight-bearing line (WBL) ratio, and joint line convergence angle (JLCA) were measured on radiographs preoperatively and after 6 months, and the differences between the pre- and post-surgery values were calculated. Post-operative WBL ratios of 57-67 % were classified as acceptable correction. WBL ratios <57 and >67 % were classified as under- and over-corrections, respectively.
RESULTS
Preoperative JLCA correlated positively with differences in MA (r = 0.358, P = 0.001) and WBL ratio (P = 0.003). Difference in JLCA showed a stronger correlation than preoperative JLCA with differences in MA (P < 0.001) and WBL ratio (P < 0.001). Difference in JLCA was the only predictor of both difference in MA (P < 0.001) and difference in WBL ratio (P < 0.001). The difference between pre- and post-operative JLCA differed significantly between the under-correction, acceptable-correction, and over-correction groups (P = 0.033). Preoperative JLCA, however, did not differ significantly between the three groups. Neither preoperative JLCA nor difference in JLCA correlated with change in posterior slope.
CONCLUSIONS
Preoperative degree of soft tissue laxity in the knee joint was related to the degree of alignment correction, but not to alignment correction error, in open-wedge HTO. Change in soft tissue laxity around the knee from before to after open-wedge HTO correlated with both correction amount and correction error. Therefore, a too large change in JLCA from before to after open-wedge osteotomy may be due to an overly large reduction in JLCA following osteotomy, suggesting alignment over-correction during surgery.
LEVEL OF EVIDENCE
II.
目的
开放性楔形高位胫骨截骨术（HTO）无法始终准确矫正下肢力线，导致矫正不足或过度矫正。本研究评估了膝关节软组织松弛与开放性楔形HTO力线矫正之间的关系。
方法
本前瞻性研究纳入了85例（86膝）因原发性内侧骨关节炎接受开放性楔形HTO的患者。在术前和术后6个月的X线片上测量机械轴（MA）、负重线（WBL）比率和关节线汇聚角（JLCA），并计算手术前后值之间的差异。术后WBL比率在57%-67%之间被归类为可接受的矫正。WBL比率<57%和>67%分别被归类为矫正不足和过度矫正。
结果
术前JLCA与MA差异（r = 0.358，P = 0.001）和WBL比率（P = 0.003）呈正相关。JLCA的差异与MA差异（P < 0.001）和WBL比率差异（P < 0.001）的相关性比术前JLCA更强。JLCA的差异是MA差异（P < 0.001）和WBL比率差异（P < 0.001）的唯一预测因素。矫正不足、可接受矫正和过度矫正组之间术前和术后JLCA的差异有显著统计学意义（P = 0.033）。然而，术前JLCA在三组之间没有显著差异。术前JLCA和JLCA的差异均与后倾角的变化无关。
结论
在开放性楔形HTO中，膝关节术前软组织松弛程度与力线矫正程度有关，但与力线矫正误差无关。开放性楔形HTO前后膝关节周围软组织松弛的变化与矫正量和矫正误差均相关。因此，开放性楔形截骨术前后JLCA变化过大可能是由于截骨后JLCA过度减小，提示手术中力线过度矫正。
证据等级
II级。
Zotero 插件