School of Postgraduate Studies, Beijing University of Chinese Medicine, Beijing, China.
Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China.
Comput Methods Programs Biomed. 2022 Jan;213:106502. doi: 10.1016/j.cmpb.2021.106502. Epub 2021 Oct 28.
High tibial osteotomy (HTO) is an effective surgical treatment for varus knee osteoarthritis. However, obese patients require reinforced internal fixation materials to prevent internal fixation fractures and hardware failure after osteotomy. Therefore, the purpose of our study is to evaluate the clinical efficacy of distal tibial tuberosity high tibial osteotomy (DTT-HTO) using the new patented π-shaped plate in obese patients with varus knee osteoarthritis.
Thirty-four obese patients (39 knees) with varus knee osteoarthritis who underwent DTT-HTO with the π-shaped plate and second-look arthroscopy when implant removal occurred from September 2017 to June 2020 were retrospectively reviewed. Three-dimensional surgical planning using DTT-HTO on the knees is performed. There were 9 males and 25 females, with body mass index (BMI) values ranging from 30.3 to 38.5 kg/m and ages ranging from 50 to 75 years old. The radiological assessment was performed with the femora tibial angle (FTA) and the weight-bearing line ratio (WBLR). The clinical outcomes were evaluated by the Hospital for Special Surgery (HSS) knee score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The status of the cartilage was evaluated by the International Cartilage Repair Society (ICRS) grading system.
All patients were followed up for 18-30 months. The FTA significantly changed from 181.68±1.68preoperatively to171.29±1.51at the last follow-up (P<0.001). The WBLR significantly increased from 16.85±2.20 to 55.41±2.46% from before surgery to the last follow-up after surgery (P<0.001). The HSS score significantly improved from 56.65±5.27 preoperatively to 68.79±2.61, 77.82±2.15, and 86.12±2.78 at the 6-month, 12-month, and last follow-up after surgery (P<0.001). The WOMAC score significantly decreased from 105.47±3.89 preoperatively to 80.50±4.20, 71.44±4.65, and 52.44±3.14 at the 6-month, 12-month, and last follow-up after surgery (P<0.001). During implant removal, no internal fixation fractures occurred in any patient. The articular cartilage grade in the medial compartment of the knee were significantly higher in the second arthroscopy than in the first arthroscopy, according to the ICRS grading system (P<0.001). The articular cartilage grade in the lateral compartment of the knee showed no statistical differences from the first- to the second-look arthroscopy (P>0.05).
There are no correlation between BMI and postoperative outcomes. DTT-HTO shows yield excellent clinical results in obese patients with varus knee osteoarthritis. It can be recommended to be used for the heavy patients.
胫骨高位截骨术（HTO）是治疗内翻型膝关节骨关节炎的有效手术方法。然而，肥胖患者需要使用强化内固定材料，以防止截骨术后内固定骨折和内固定失败。因此，我们的研究目的是评估新型专利π形钢板在伴有内翻型膝关节骨关节炎的肥胖患者中行胫骨结节高位胫骨截骨术（DTT-HTO）的临床疗效。
回顾性分析 2017 年 9 月至 2020 年 6 月间因植入物取出而行二次关节镜检查的 34 例（39 膝）伴有内翻型膝关节骨关节炎的肥胖患者（BMI 值为 30.3-38.5kg/m²，年龄 50-75 岁）的 DTT-HTO 与 π形钢板的临床资料。对膝关节进行三维手术规划。其中男性 9 例，女性 25 例。术后采用股骨胫骨角（FTA）和负重线比（WBLR）进行影像学评估，采用美国特种外科医院（HSS）膝关节评分和西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评估临床疗效，采用国际软骨修复协会（ICRS）分级系统评估软骨状态。
所有患者均获得 18-30 个月的随访。FTA 由术前的 181.68±1.68°显著改善至末次随访时的 171.29±1.51°（P<0.001）。WBLR 由术前的 16.85±2.20%显著增加至术后的 55.41±2.46%（P<0.001）。HSS 评分由术前的 56.65±5.27 分显著改善至术后 6 个月时的 68.79±2.61 分、12 个月时的 77.82±2.15 分和末次随访时的 86.12±2.78 分（P<0.001）。WOMAC 评分由术前的 105.47±3.89 分显著降低至术后 6 个月时的 80.50±4.20 分、12 个月时的 71.44±4.65 分和末次随访时的 52.44±3.14 分（P<0.001）。在取出内固定物时，所有患者均未发生内固定骨折。根据 ICRS 分级系统，第二次关节镜检查时膝关节内侧间室的软骨分级显著高于第一次关节镜检查（P<0.001）。而膝关节外侧间室的软骨分级在第一次和第二次关节镜检查之间无统计学差异（P>0.05）。
BMI 与术后结果之间无相关性。DTT-HTO 可为伴有内翻型膝关节骨关节炎的肥胖患者提供良好的临床效果，可以推荐用于体重较重的患者。
