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, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing 100029, China.
Comput Methods Programs Biomed. 2022 Jun;221:106923. doi: 10.1016/j.cmpb.2022.106923. Epub 2022 May 29.
To observe the cartilage repair of the medial compartment and the biomechanical changes of the lower extremities after single-plane high tibial osteotomy of distal tibial tuberosity (DTT-HTO).
A total of 30 patients, including 11 males and 19 females, who underwent DTT-HTO with arthroscopic operation in our hospital from January 2020 to January 2021 and underwent arthroscopic exploration again during the second operation for internal fixation were enrolled. There were 32 knees, including 13 left knees and 19 right knees. Age ranged from 50 to 78, with an average of 63.20 ± 6.61 years old. All patients completed two surgeries and were followed up, and no adverse events occurred during the period. International Cartilage Repair Society (ICRS) was used to assess the cartilage condition of the medial compartment of the knee during the two surgeries. In this paper, the weight-bearing line ratio (WBLR), the medial proximal tibia angle (MPTA), the femoral tibial angle (FTA) and the posterior tibial slope (PTS) were used to evaluate the changes of the mechanical state of the lower limbs. The visual analogue scale (VAS) score and the Western Ontario and McMaster University Osteoarthritis (WOMAC) Index score were used to evaluate the improvement in knee pain and function.
All patients completed two operations without adverse events and serious complications. The medial compartment cartilage of all patients had different degrees of repair during the second operation, and the difference was statistically significant compared with the first operation (P < 0.05). During the second operation, the WBLR was corrected from (17.69 ± 2.16)% to (60.90 ± 1.97)%, the MPTA was corrected from (80.72 ± 1.61)° to (89.91 ± 2.58)°, the FTA was corrected from (182.31 ± 3.03)° to (171.81 ± 2.24)°, the difference was statistically significant (P < 0.05). There was no statistical difference in PTS between the two surgeries (P > 0.05). At the second operation, the VAS score decreased from 7.50 ± 1.34 to 0.34 ± 0.85, the WOMAC score decreased from 119.50 ± 10.43 to 46.25 ± 4.13, and the difference was statistically significant (P < 0.05).
DTT-HTO can significantly correct the weight-bearing line, restore the biomechanical parameters of the lower limb to the normal range, significantly relieve pain and improve knee function, and the medial compartment cartilage repair and regeneration phenomenon will occur after the correction of the weight-bearing line.
观察胫骨结节下内侧关节面（DTT）单平面胫骨高位截骨（HTO）后对膝关节内侧间室的软骨修复和下肢生物力学的影响。
选取 2020 年 1 月至 2021 年 1 月在我院行 DTT-HTO 并在二次手术中再次行关节镜探查的患者 30 例，其中男 11 例，女 19 例，共 32 膝，左侧 13 膝，右侧 19 膝。年龄 50~78 岁，平均 63.20±6.61 岁。所有患者均完成了两次手术和随访，在此期间未发生不良事件。采用国际软骨修复协会（ICRS）评分评估两次手术时膝关节内侧间室的软骨情况。本文采用负重对线比（WBLR）、内侧胫骨近端角（MPTA）、股骨胫骨角（FTA）和胫骨后倾角（PTS）来评估下肢力学状态的变化。采用视觉模拟评分（VAS）和西部安大略省和麦克马斯特大学骨关节炎（WOMAC）指数评分评估膝关节疼痛和功能的改善情况。
所有患者均顺利完成两次手术，无不良事件和严重并发症发生。所有患者的膝关节内侧间室软骨在第二次手术时有不同程度的修复，与第一次手术相比差异有统计学意义（P<0.05）。第二次手术时，WBLR 从（17.69±2.16）%校正至（60.90±1.97）%，MPTA 从（80.72±1.61）°校正至（89.91±2.58）°，FTA 从（182.31±3.03）°校正至（171.81±2.24）°，差异有统计学意义（P<0.05）。两次手术 PTS 差异无统计学意义（P>0.05）。第二次手术时，VAS 评分从 7.50±1.34 降至 0.34±0.85，WOMAC 评分从 119.50±10.43 降至 46.25±4.13，差异有统计学意义（P<0.05）。
DTT-HTO 可显著纠正负重线，将下肢生物力学参数恢复至正常范围，明显缓解疼痛，改善膝关节功能，且在纠正负重线后可出现内侧间室软骨修复和再生现象。
