Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2021 Apr;29(4):1035-1044. doi: 10.1007/s00167-020-06076-4. Epub 2020 May 27.
This study aimed to evaluate (1) the efficacy of varus-valgus stress radiographs to adjust the preoperative soft-tissue imbalance and (2) ascertain whether varus-valgus stress radiographs are effective for the correction accuracy in the preoperative planning of the opening wedge high tibial osteotomy (OWHTO).
From February 2017 to December 2018, a total of 121 consecutive knees that underwent bi-planar OWHTO were enrolled in this retrospective analysis. Preoperative planning was performed using a weight-bearing line (WBL). Target WBL was determined according to the status of the medial compartments such as cartilage, meniscus, and preoperative arthritic grade. Preoperative varus-valgus stress radiographs were used to assess the preoperative mediolateral ligament imbalance. The final target correction length of the opening gap was determined by subtracting the difference between the varus-valgus stress radiographs (VVD). All patients were divided into two groups according to the preoperatively planned correction degree: (group A), smaller than average; (group B), larger than average. Patients were also divided into two other groups (VVD adjusted and neglected groups).
Groups A and B were 56 and 54 knees, respectively. The preoperatively planned correction lengths of the opening gap were 9.33 ± 1.5 and 14.16 ± 3.96 mm, respectively (p < 0.01). Mean values of the VVD were 0.85 ± 0.72, and 1.27 ± 1.78 mm, respectively (p < 0.01). Correction errors were 2.17 ± 2.06 and 3.52 ± 2.16%, respectively (p < 0.01). Planned and final correction degrees were also significantly larger (p < 0.01, and p < 0.01, respectively), because the preoperative WBL ratio was significantly smaller in the VVD adjusted group (p < 0.01).
The VVD values could reproduce the preoperative soft-tissue imbalance and it was more prominent as the correction degree increased. The strategy of subtracting the VVD as assumed soft-tissue imbalance in the preoperative planning worked well for the correction accuracy during OWHTO.
Level IV, retrospective study.
本研究旨在评估（1）内外翻应力位 X 线片在调整术前软组织失衡方面的疗效，以及（2）内外翻应力位 X 线片在开放楔形胫骨高位截骨术（OWHTO）术前规划中的矫正准确性是否有效。
回顾性分析 2017 年 2 月至 2018 年 12 月期间行双平面 OWHTO 的 121 例连续膝关节。术前规划采用负重位线（WBL）。根据软骨、半月板和术前关节炎分级等内侧间隙的状况确定目标 WBL。术前内外翻应力位 X 线片用于评估术前内外侧韧带不平衡。通过减去内外翻位 X 线片（VVD）之间的差异，确定最终开口间隙的目标矫正长度。所有患者根据术前计划的矫正程度分为两组：（A 组）小于平均值；（B 组）大于平均值。患者还根据术前计划的矫正程度分为两组（VVD 调整组和忽视组）。
A 组和 B 组分别为 56 例和 54 例膝关节。开口间隙的术前计划矫正长度分别为 9.33 ± 1.5 和 14.16 ± 3.96mm（p<0.01）。VVD 的平均值分别为 0.85 ± 0.72 和 1.27 ± 1.78mm（p<0.01）。矫正误差分别为 2.17 ± 2.06%和 3.52 ± 2.16%（p<0.01）。计划和最终的矫正程度也显著更大（p<0.01，p<0.01），因为 VVD 调整组的术前 WBL 比例显著更小（p<0.01）。
VVD 值可以再现术前软组织失衡，且随着矫正程度的增加，失衡越明显。在 OWHTO 中，将 VVD 减去作为术前假设的软组织失衡的策略在矫正准确性方面效果良好。
IV 级，回顾性研究。
