内侧开放楔形胫骨高位截骨术后不同时间点的关节间隙宽度在内外侧呈不同程度增加。
Joint Space Width Increases Medially and Decreases Laterally at Different Time Points After Medial Open-Wedge High Tibial Osteotomy.
机构信息
Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan, Republic of Korea; Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
Arthroscopy. 2021 Nov;37(11):3316-3323. doi: 10.1016/j.arthro.2021.04.007. Epub 2021 Apr 30.
PURPOSE
To evaluate the serial changes in the joint space width (JSW) of the medial and lateral compartments after medial open-wedge high tibial osteotomy (MOWHTO) and its associated factors.
METHODS
The medial and lateral weight-bearing JSWs were measured on serial radiographs and analyzed preoperatively and postoperatively within 2 weeks, as well as at 3 months, 6 months, 1 year, and 2 years. Associations between the medial and lateral JSWs and age, body mass index, mechanical axis, correction angle, lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle (JLCA), JLCA on stress radiographs, and arthroscopic cartilage status were examined. Clinical outcome was measured according to the Knee Society objective and functional scores.
RESULTS
Seventy-one patients who underwent MOWHTO with locking-plate fixation were analyzed. The respective mean medial and lateral JSWs on serial radiographs were as follows: 3.08 mm and 5.14 mm preoperatively, 3.10 mm and 4.63 mm postoperatively, 3.37 mm and 4.57 mm at 3 months, 3.40 mm and 4.59 mm at 6 months, 3.44 mm and 4.57 mm at 1 year, and 3.42 mm and 4.64 mm at 2 years. At 3 months, the medial JSW increased (P < .001), whereas the lateral JSW decreased immediately (P < .001). JSW showed no significant differences at other time points. Preoperative and postoperative JLCAs and medial femoral and tibial cartilage grades were associated with medial JSW changes (P = .021). However, no significant parameters were associated with decreases in the lateral JSW (P > .05). The postoperative Knee Society objective and functional scores improved and were maintained.
CONCLUSIONS
After MOWHTO, the medial JSW increased at 3 months postoperatively and the lateral JSW decreased immediately. The preoperative and postoperative JLCAs and the medial femoral and tibial cartilage grades were associated with the change in the medial JSW. However, no significant parameters were associated with the decrease in the lateral JSW.
LEVEL OF EVIDENCE
Level IV, case series of therapeutic study.
目的
评估内侧开放楔形胫骨高位截骨术（MOWHTO）后内侧和外侧关节间隙宽度（JSW）的连续变化及其相关因素。
方法
在术前和术后 2 周内，以及术后 3 个月、6 个月、1 年和 2 年内，分别测量内侧和外侧负重 JSW，并进行分析。检查内侧和外侧 JSW 与年龄、体重指数、力学轴、矫正角度、外侧远端股骨角、内侧近端胫骨角、关节线会聚角（JLCA）、应力位 X 线片上的 JLCA 和关节镜下软骨状况之间的关系。根据膝关节协会的客观和功能评分来测量临床结果。
结果
对 71 例接受锁定钢板固定的 MOWHTO 患者进行了分析。连续 X 线片上的平均内侧和外侧 JSW 分别为：术前 3.08mm 和 5.14mm，术后 3.10mm 和 4.63mm，术后 3 个月 3.37mm 和 4.57mm，术后 6 个月 3.40mm 和 4.59mm，术后 1 年 3.44mm 和 4.57mm，术后 2 年 3.42mm 和 4.64mm。术后 3 个月，内侧 JSW 增加（P<0.001），而外侧 JSW 立即减少（P<0.001）。在其他时间点，JSW 无显著差异。术前和术后的 JLCA 以及内侧股骨和胫骨软骨分级与内侧 JSW 变化相关（P=0.021）。然而，没有与外侧 JSW 减少相关的显著参数（P>0.05）。术后膝关节协会的客观和功能评分得到改善并保持。
结论
MOWHTO 后，术后 3 个月内侧 JSW 增加，外侧 JSW 立即减少。术前和术后的 JLCA 以及内侧股骨和胫骨软骨分级与内侧 JSW 的变化有关。然而，没有与外侧 JSW 减少相关的显著参数。
证据等级
IV 级，治疗性研究的病例系列。
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