Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany.
OT Medizintechnik GmbH (Medical Engineering in Orthopedics and Traumatology), Munich, Germany.
J Orthop Surg (Hong Kong). 2022 May-Aug;30(2):10225536221101699. doi: 10.1177/10225536221101699.
In medial open-wedge high tibial osteotomy (HTO) hinge axis and osteotomy plane influence the resulting anatomy, but accurate angular quantifications using 3D-planning-simulations are lacking. The objectives of this study were developing a standardized and validated 3D-planning method of an HTO and to perform several simulated realignments to explain unintended anatomy changes. The cutting direction of the main osteotomy was defined parallel to the medial tibial slope and the hinge axis 1.5 cm distal to the lateral plateau. For interobserver testing, this 3D planning was performed on 13 digital models of human tibiae by two observers. In addition, four different hinge axis positions and five differently inclined osteotomy planes each were simulated. The osteotomy direction ranged from medial 0°-30° anteromedial, while the tilt of the osteotomy plane compared to the tibial plateau was -10° to +10°. All anatomic angular changes were calculated using 3D analysis. Multiple HTO plannings by two medical investigators using standardized procedures showed only minimal differences. In the 3D-simulation, each 10° rotation of the hinge axis resulted in a 1.7° significant increase in slope. Tilting the osteotomy plane by 10° resulted in significant torsional changes of 2°, in addition to minor but significant changes in the medial proximal tibial angle (MPTA). Standardized 3D-planning of the HTO can be performed with high reliability using two-observer planning. 3D-simulations suggest that control of the osteotomy plane is highly relevant to avoid unintended changes in the resulting anatomy, but this can be a helpful tool to modify specific angles in different pathologies in the HTO.
在胫骨高位截骨术（HTO）中，内侧撑开楔形的铰链轴和截骨平面会影响最终的解剖结构，但缺乏使用 3D 规划模拟进行精确角度定量的方法。本研究的目的是开发一种标准化和验证的 HTO 3D 规划方法，并进行多次模拟的重新定位，以解释非预期的解剖结构变化。主要截骨的切割方向定义为与内侧胫骨斜率平行，铰链轴位于外侧平台远端 1.5cm 处。为了进行观察者间测试，两位观察者对 13 个人类胫骨的数字模型进行了 3D 规划。此外，还模拟了五个不同倾斜的截骨平面和四个不同的铰链轴位置。截骨方向从内侧 0°-30°前内侧，而截骨平面相对于胫骨平台的倾斜度为-10°至+10°。所有解剖角度变化均使用 3D 分析进行计算。两位医学研究者使用标准化程序进行的多次 HTO 规划显示，只有微小的差异。在 3D 模拟中，铰链轴每旋转 10°，斜率会显著增加 1.7°。截骨平面倾斜 10°会导致明显的扭转变化 2°，此外，内侧近端胫骨角（MPTA）也会发生微小但显著的变化。使用两位观察者进行标准化的 HTO 3D 规划具有很高的可靠性。3D 模拟表明，控制截骨平面对于避免预期外的解剖结构变化非常重要，但这是在 HTO 中修改不同病理特定角度的有用工具。
