Steadman Clinic, Vail, Colorado, U.S.A.; Steadman Philippon Research Institute, Vail, Colorado, U.S.A..
Steadman Clinic, Vail, Colorado, U.S.A.; Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Arthroscopy. 2021 Jul;37(7):2181-2188. doi: 10.1016/j.arthro.2021.01.065. Epub 2021 Feb 10.
The purpose of this study is (1) to determine if, when optimizing modern techniques, medial opening-wedge osteotomies can effectively maintain tibial slope and (2) to determine how different magnitude coronal plane corrections affect tibial slope.
Proximal tibial osteotomies (PTOs) were performed on 10 fresh-frozen cadaveric knees leaving a consistent lateral hinge, using either a 5-mm or a 10-mm trapezoidal wedged osteotomy plate. Techniques including posterior plate placement; a trapezoidal, sloped plate; and knee hyperextension were used during plate fixation to help close the anterior osteotomy gap. Medial coronal proximal tibia angle and posterior tibial slope were measured preosteotomy, after a 5-mm implant, and after a 10-mm implant using true anteroposterior and lateral fluoroscopic images. Three independent observers performed all radiographic measurements, and intraclass correlation coefficients were calculated.
The 5-mm and 10-mm osteotomy plates increased the coronal medial proximal tibia angle by a mean of 3.4° (range, 3.0°-3.7°) and 7.3° (range, 6.7°-7.7°), respectively. The 5-mm and 10-mm trapezoidal wedged osteotomy plates decreased the posterior tibial slope by a mean of 0.9° (range, 0.5°-1.2°) and 0.3° (range, 0°-0.6°), respectively. Intraobserver reliability was found to be high for both the coronal medial proximal tibia angle (intraclass correlation coefficient [ICC] = 0.897 [0.821-0.946]) and the tibial slope measurements (ICC = 0.761 [0.672-0.826]).
When optimizing the medial opening-wedge proximal tibial osteotomy, including utilization of a sagittally oriented hinge, placement of a trapezoidal plate posteriorly, and fixation with knee hyperextension, posterior tibial slope can be maintained regardless of the degree of coronal correction.
Tibial slope has a significant effect on cruciate ligament stress and a better understanding of coronal plane correction, and its effect on tibial slope is critical when performing proximal tibia osteotomies.
本研究旨在（1）确定在优化现代技术时，内侧开口楔形截骨术是否能有效维持胫骨倾斜度，以及（2）确定不同程度冠状面矫正如何影响胫骨倾斜度。
在 10 个新鲜冷冻尸体膝关节上进行胫骨近端截骨术（PTO），保留一致的外侧铰链，使用 5mm 或 10mm 梯形楔形截骨板。在钢板固定过程中使用了包括后钢板放置、梯形倾斜钢板和膝关节过度伸展在内的技术，以帮助闭合前侧截骨间隙。使用真正的前后位和侧位荧光透视图像，在截骨前、植入 5mm 植入物后和植入 10mm 植入物后测量内侧冠状胫骨近端角和胫骨后倾角。三位独立观察者进行了所有放射学测量，并计算了组内相关系数。
5mm 和 10mm 截骨板分别将冠状面内侧胫骨近端角平均增加 3.4°（范围，3.0°-3.7°）和 7.3°（范围，6.7°-7.7°）。5mm 和 10mm 梯形楔形截骨板平均使胫骨后倾角减小 0.9°（范围，0.5°-1.2°）和 0.3°（范围，0°-0.6°）。对于冠状面内侧胫骨近端角（组内相关系数 [ICC] 0.897 [0.821-0.946]）和胫骨斜率测量值（ICC 0.761 [0.672-0.826]），观察者内可靠性均较高。
在优化内侧开口楔形胫骨近端截骨术时，包括使用矢状位铰链、将梯形钢板放置在后方以及使用膝关节过度伸展固定，无论冠状面矫正程度如何，都可以维持胫骨后倾角。
胫骨斜率对交叉韧带的应力有重要影响，对冠状面矫正的理解也很重要，在进行胫骨近端截骨术时，了解冠状面矫正及其对胫骨斜率的影响至关重要。
