Chen Haojie, Wang Bin, Chen Xu, Yu Jinwei, Guo Jiarui, Li Derong, Li Wenjing, Huang Xiaoqiang
Department of Orthopedics, Jiaozuo Second People's Hospital, Jiaozuo Henan, 454100, P. R. China.
Department of Orthopedics, Xi'an Fifth People's Hospital, Xi'an Shaanxi, 710082, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jun 15;37(6):670-674. doi: 10.7507/1002-1892.202302021.
To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis.
The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m ), overweight group (27 patients in group B, BMI>30 kg/m ), and obese group (25 patients in group C, BMI>30 kg/m ). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m , respectively. There was no significant difference ( >0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy.
All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups ( >0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% 3.7% 8.0%) ( =0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation ( <0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation ( >0.05).
BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.
探讨体重指数（BMI）对高位胫骨截骨术（HTO）治疗膝内翻性膝关节炎短期疗效的影响。
回顾性分析2016年5月至2020年8月间84例（84膝）接受HTO治疗的膝内翻性膝关节炎患者的临床资料。根据BMI将患者分为正常组（A组32例，BMI<25 kg/m²）、超重组（B组27例，BMI>30 kg/m²）和肥胖组（C组25例，BMI>30 kg/m²）。A、B、C组的BMI分别为（23.35±0.89）、（26.65±1.03）和（32.05±1.47）kg/m²。各组间在性别、年龄、手术侧、病程以及术前特种外科医院（HSS）评分、视觉模拟评分法（VAS）评分、膝关节活动范围和髋-膝-踝角（HKA）方面差异均无统计学意义（P>0.05）。记录并比较各组间的手术时间、术中主要失血量以及术后第3天血红蛋白的下降情况。通过术前、术后膝关节HSS评分、膝关节活动范围和VAS评分以及测量患者X线片上的HKA来评估膝关节功能和疼痛状态的改善情况。随访期间复查膝关节X线片，观察内固定器位置及截骨愈合情况。
所有患者手术均成功完成，随访8～40个月（平均19.3个月）。各组间随访时间、手术时间、术中主要失血量以及术后第3天血红蛋白的下降情况差异均无统计学意义（P>0.05）。未发生严重血管或神经损伤等手术并发症。术后A组和B组分别有1例发生下肢深静脉血栓形成，C组有2例发生手术切口脂肪液化。各组围手术期并发症发生率差异无统计学意义（3.1%、3.7%、8.0%）（P=0.689）。随访期间，未发生骨不连、钢板骨折或松动。末次随访时，3组的HSS评分、VAS评分、膝关节活动范围和HKA与术前相比均显著改善（P<0.05），但各组上述指标术前、术后差值比较差异无统计学意义（P>0.05）。
BMI不影响HTO治疗膝内翻性膝关节炎的短期疗效。对于超重和肥胖患者，在规范内科治疗无效后可选择HTO治疗。
