Nie Yong, Ma Jun, Huang ZeYu, Xu Bin, Tang Shuo, Shen Bin, Kraus Virginia Byers, Pei FuXing
Department of Orthopedic Surgery, West China Hospital, West China Medical School, SiChuan University, ChengDu, SiChuan Province, People's Republic of China.
Department of Orthopedic Surgery, West China Hospital, West China Medical School, SiChuan University, ChengDu, SiChuan Province, People's Republic of China; Duke Molecular Physiology Institute, Duke University School of Medicine, Duke University, Durham, NC, United States.
J Biomech. 2018 Apr 11;71:22-29. doi: 10.1016/j.jbiomech.2017.12.004. Epub 2017 Dec 13.
To investigate the change in clinical outcomes and biomechanical properties of the knee in response to upper partial fibulectomy. Sixteen patients with medial compartment knee osteoarthritis (KOA) underwent upper partial fibulectomy. Visual analog scale (VAS) pain, the hospital for special surgery knee score (HSS), hip-knee-ankle (HKA) angle (measured in the frontal plane), and flexion/extension range of motion of the knee were assessed before and up to 6 months after surgery. Patients were evaluated for gait parameters and overall peak knee adduction moment (KAM). Patient-specific finite element knee models were developed to investigate changes in load in response to fibulectomy. Both VAS pain and HSS score were significantly improved (P < .001) one day after surgery and steadily improved during the subsequent 6 months. HKA angle improved (P = .006) immediately and remained stable by 3 months after surgery. A significant inverse relationship (R = -0.528, P = .012) between the overall peak KAM (decreased by 19.1%) and the HKA (increased by 1.24° from a more varus to more neutral alignment) angle was observed. The minor load supported by the fibula preoperatively was spread post-operatively over the cortical bone of the tibial shaft. The mean stress in the medial tibial plateau was significantly decreased (P < .001), with a portion of the stress transferred to the posterior-lateral region of the tibial plateau after upper partial fibulectomy. This pilot study provides objective 3D gait and plausible biomechanical evidence for the improvement in clinical symptoms from partial upper fibulectomy.
为研究上半部分腓骨切除术对膝关节临床疗效和生物力学特性的影响。16例内侧间室膝关节骨关节炎（KOA）患者接受了上半部分腓骨切除术。在手术前及术后长达6个月的时间里，评估视觉模拟量表（VAS）疼痛评分、特种外科医院膝关节评分（HSS）、髋-膝-踝（HKA）角（在额面测量）以及膝关节屈伸活动范围。对患者的步态参数和整体膝关节内收峰值力矩（KAM）进行评估。建立患者特异性有限元膝关节模型，以研究腓骨切除术后负荷的变化。术后1天，VAS疼痛评分和HSS评分均显著改善（P<0.001），并在随后的6个月内持续改善。HKA角立即改善（P = 0.006），术后3个月保持稳定。观察到整体峰值KAM（下降19.1%）与HKA角（从更内翻到更中立的对线增加1.24°）之间存在显著的负相关（R = -0.528，P = 0.012）。术前由腓骨支撑的较小负荷在术后分散到胫骨干的皮质骨上。上半部分腓骨切除术后，胫骨内侧平台的平均应力显著降低（P<0.001），部分应力转移至胫骨平台的后外侧区域。这项初步研究为上半部分腓骨切除术改善临床症状提供了客观的三维步态和合理的生物力学证据。
