Department of Clinical, Jining Medical University, Jining, Shandong, China.
Department of Orthopedics and Joints, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
BMC Surg. 2022 May 13;22(1):177. doi: 10.1186/s12893-022-01629-5.
To investigate the effect of the ratio of the medial tibial plateau width to the total tibial plateau width on the therapeutic efficacy of high tibial osteotomy (HTO) on the medial side for the treatment of knee osteoarthritis.
In this study, we retrospectively analyzed information of 278 patients who underwent medial HTO for knee osteoarthritis with varus deformity. The Tinetti Gait and Balance Assessment Tool, the Visual Analog Scale (VAS), and the Knee Society Scoring System (KSS) were used to comprehensively evaluate the function of the knee joint after HTO.
After adjusting for potential confounding factors (i.e., age, gender, body mass index/BMI, and surgical site), the Tinetti assessment score was optimized when the degree of correction was 53.67%, with the β-value on the left and right sides of the inflection point of 0.49 (confidence interval, CI: 0.20, 0.78, P = 0.0009) and- 0.26 (95% CI: - 0.30, - 0.22, P < 0.0001), respectively. The KSS score was optimized when the degree of correction was 55.45%, with the β-value on the left and right sides of the inflection point of 2.77 (95% CI: 1.64, 3.90, P < 0.0001) and - 1.18 (95% CI: - 1.46, - 0.91, P < 0.0001), respectively. The VAS score was the lowest when the degree of correction was 55.00%, with the β-value on the left and right sides of the inflection point of - 0.16 (95% CI: - 0.29, - 0.03, P = 0.0146) and 0.08 (95% CI: 0.05, 0.10, P < 0.0001), respectively. Stratified analysis showed that the BMI affected the Tinetti assessment score (β = - 0.14, 95% CI: - 0.24, - 0.04, P = 0.0071). According to the smooth-curve fitting results, when the BMI was > 28, the Tinetti assessment score showed a negative trend.
The degree of lower-limb mechanical axis correction correlated with the functional status of the knee joint after MOW HTO. When the ratio of the medial tibial plateau width to the total tibial plateau width was approximately 55%, the post-MOW HTO outcomes were optimized and the patients experienced the highest satisfaction. In addition, very high BMI was not conducive for the postoperative recovery of the knee joint function.
III Case-control study/Retrospective comparative study.
探讨胫骨平台内侧宽度与胫骨平台总宽度之比对内侧高位胫骨截骨（HTO）治疗膝骨关节炎疗效的影响。
本研究回顾性分析了 278 例接受内侧 HTO 治疗的膝内翻畸形骨关节炎患者的信息。采用 Tinetti 步态和平衡评估工具、视觉模拟量表（VAS）和膝关节协会评分系统（KSS）综合评估 HTO 后膝关节功能。
在调整潜在混杂因素（即年龄、性别、体重指数/BMI 和手术部位）后，左侧和右侧拐点处的β值分别为 0.49（置信区间，0.20，0.78，P = 0.0009）和-0.26（95%置信区间，-0.30，-0.22，P < 0.0001）时，Tinetti 评估评分得到优化。KSS 评分在矫正度为 55.45%时得到优化，左侧和右侧拐点处的β值分别为 2.77（95%置信区间，1.64，3.90，P < 0.0001）和-1.18（95%置信区间，-1.46，-0.91，P < 0.0001）。当矫正度为 55.00%时，VAS 评分最低，左侧和右侧拐点处的β值分别为-0.16（95%置信区间，-0.29，-0.03，P = 0.0146）和 0.08（95%置信区间，0.05，0.10，P < 0.0001）。分层分析表明，BMI 影响 Tinetti 评估评分（β = -0.14，95%置信区间，-0.24，-0.04，P = 0.0071）。根据平滑曲线拟合结果，当 BMI 大于 28 时，Tinetti 评估评分呈负相关趋势。
下肢机械轴矫正程度与 MOW HTO 后膝关节功能状态相关。当胫骨平台内侧宽度与胫骨平台总宽度之比约为 55%时，MOW HTO 后的结果得到优化，患者满意度最高。此外，非常高的 BMI 不利于膝关节功能的术后恢复。
III 类病例对照研究/回顾性比较研究。
