内侧开放楔形高位胫骨截骨术后踝关节和髋关节的变化会影响膝关节线倾斜度。
Changes in ankle and hip joints following medial opening-wedge high tibial osteotomy affect knee joint line obliquity.
作者信息
Kim Sang-Gyun, Jun June-Bum, Bae Il Wook, Lee Dae-Hee
机构信息
Department of Orthopaedic Surgery, National Medical Center, Seoul, South Korea.
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5420-5427. doi: 10.1007/s00167-023-07581-y. Epub 2023 Oct 1.
PURPOSE
This study aimed to measure the change in knee joint line obliquity (KJLO) and the changes in radiologic parameters of the ankle and hip joints after medial opening-wedge high tibial osteotomy (MOWHTO), and to evaluate the correlation and causal relationship between these parameters.
METHODS
This study evaluated 109 patients who underwent MOWHTO between April 2015 and December 2021. Radiologic parameters, including KJLO, medial proximal tibial angle (MPTA), ankle joint line obliquity (AJLO), and hip abduction angle (HAA), were analysed before and 1 year after MOWHTO. Multiple linear regression analysis was used to identify independent variables that significantly affected the change in KJLO after MOWHTO. Receiver operating characteristic (ROC) analysis was used to evaluate the cutoff value for a change in KJLO that exceeded 5° postoperatively, and the predicting values of radiologic parameters.
RESULTS
Multiple linear regression analysis showed that changes in MPTA, AJLO, and HAA (β = 0.440, P < 0.001; β = - 0.310, P < 0.001; β = 0.164, P = 0.035, respectively) were predictors of the change in KJLO after MOWHTO. ROC analysis showed that the threshold value for a change in KJLO which exceeded 5° postoperatively was 4.6° (66.7% sensitivity, 63.8% specificity, P = 0.025). Moreover, ROC curves for predicting a change in KJLO of > 4.6° showed that the AUC was significantly higher for the change in MPTA than that of the other two parameters (P = 0.011 for AJLO and P < 0.001 for HAA).
CONCLUSION
MOWHTO increases the KJLO by valgization of the proximal tibia and causes hip adduction and ankle valgization. The postoperative ankle valgization after MOWHTO could reduce the increase in KJLO, counteracting the effects of proximal tibial valgization and hip adduction. Therefore, the effects of the hip and ankle joints should be considered to achieve an optimal KJLO and satisfactory clinical outcomes after MOWHTO.
LEVEL OF STUDY
Cohort study, IV.
目的
本研究旨在测量内侧开口楔形高位胫骨截骨术（MOWHTO）后膝关节间隙倾斜度（KJLO）的变化以及踝关节和髋关节放射学参数的变化，并评估这些参数之间的相关性和因果关系。
方法
本研究评估了2015年4月至2021年12月期间接受MOWHTO的109例患者。分析了MOWHTO术前及术后1年的放射学参数，包括KJLO、胫骨近端内侧角（MPTA）、踝关节间隙倾斜度（AJLO）和髋关节外展角（HAA）。采用多元线性回归分析确定对MOWHTO后KJLO变化有显著影响的独立变量。采用受试者工作特征（ROC）分析评估术后KJLO变化超过5°的临界值以及放射学参数的预测价值。
结果
多元线性回归分析显示，MPTA、AJLO和HAA的变化（β分别为0.440，P<0.001；β为-0.310，P<0.001；β为0.164，P=0.035）是MOWHTO后KJLO变化的预测因素。ROC分析显示术后KJLO变化超过5°的阈值为4.6°（敏感性66.7%，特异性63.8%，P=0.025）。此外，预测KJLO变化>4.6°的ROC曲线显示，MPTA变化的曲线下面积（AUC）显著高于其他两个参数（AJLO为P=0.011，HAA为P<0.001）。
结论
MOWHTO通过胫骨近端外翻增加KJLO，并导致髋关节内收和踝关节外翻。MOWHTO术后的踝关节外翻可减少KJLO的增加，抵消胫骨近端外翻和髋关节内收的影响。因此，为在MOWHTO后获得最佳的KJLO和满意的临床结果，应考虑髋关节和踝关节的影响。
研究水平
队列研究，IV级。
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