Black Marianne S, d'Entremont Agnes G, McCormack Robert G, Hansen Gregory, Carr Derek, Wilson David R
University of British Columbia, Department of Mechanical Engineering, 2054-6250 Applied Science Lane, Vancouver V6T 1Z4, BC, Canada; Centre for Hip Health and Mobility, 2635 Laurel Street, Vancouver V5Z 1M9, BC, Canada.
University of British Columbia, Department of Mechanical Engineering, 2054-6250 Applied Science Lane, Vancouver V6T 1Z4, BC, Canada; Centre for Hip Health and Mobility, 2635 Laurel Street, Vancouver V5Z 1M9, BC, Canada.
Clin Biomech (Bristol). 2018 Jan;51:17-25. doi: 10.1016/j.clinbiomech.2017.10.021. Epub 2017 Nov 2.
High tibial osteotomy is a surgical procedure to treat medial compartment osteoarthritis in varus knees. The reported success rates of the procedure are inconsistent, which may be due to sagittal plane alignment of the osteotomy. The objective of this study was to determine the effect of changing tibial slope, for a range of tibial wedge angles in high tibial osteotomy, on knee joint contact pressure location and kinematics during continuous loaded flexion/extension.
Seven cadaveric knee specimens were cycled through flexion and extension in an Oxford knee-loading rig. The osteotomy on each specimen was adjusted to seven clinically relevant wedge and slope combinations. We used pressure sensors to determine the position of the centre of pressure in each compartment of the tibial plateau and infrared motion capture markers to determine tibiofemoral and patellofemoral kinematics.
In early knee flexion, a 5° increase in tibial slope shifted the centre of pressure in the medial compartment anteriorly by 4.5mm (P≤0.001), (from the neutral slope/wedge position). Increasing the tibial slope also resulted in the tibia translating anteriorly (P≤0.001).
Changes to the tibial slope during high tibial osteotomy for all tested wedge angles shifted the centre of pressure in both the medial and lateral compartments substantially and altered knee kinematics. Tibial slope should be controlled during high tibial osteotomy to prevent unwanted changes in tibial plateau contact loads.
高位胫骨截骨术是一种治疗内翻膝内侧间室骨关节炎的外科手术。该手术报道的成功率并不一致，这可能是由于截骨术矢状面的对线情况。本研究的目的是确定在高位胫骨截骨术中，对于一系列胫骨楔形角度改变胫骨坡度，在持续负重屈伸过程中对膝关节接触压力位置和运动学的影响。
七个尸体膝关节标本在牛津膝关节加载装置中进行屈伸循环。每个标本的截骨术被调整为七种临床相关的楔形和坡度组合。我们使用压力传感器确定胫骨平台每个间室的压力中心位置，并使用红外运动捕捉标记物确定胫股和髌股运动学。
在膝关节早期屈曲时，胫骨坡度增加5°使内侧间室的压力中心向前移动4.5毫米（P≤0.001），（相对于中立坡度/楔形位置）。增加胫骨坡度还导致胫骨向前平移（P≤0.001）。
在高位胫骨截骨术中，对于所有测试的楔形角度，胫骨坡度的改变使内侧和外侧间室的压力中心都发生了显著变化，并改变了膝关节运动学。在高位胫骨截骨术中应控制胫骨坡度，以防止胫骨平台接触负荷出现不必要的变化。
