Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2024 Jan;32(1):64-77. doi: 10.1002/ksa.12022. Epub 2024 Jan 3.
PURPOSE: The aim of this study was to analyse the factors associated with additional postoperative alignment changes after accurate bony correction by selecting only patients with well-performed bony correction as planned and develop a method of incorporating significant factors into preoperative planning. METHODS: Among 104 consecutive patients who underwent medial open wedge high tibial osteotomy (MOWHTO) between October 2019 and July 2022, 61 with well-performed bony corrections were retrospectively reviewed. The major criterion for well-performed bony correction was a difference of <1° between the simulated medial proximal tibial angle (MPTA) and the actual postoperative MPTA as measured in three dimensions. Radiographic parameters, such as the joint line convergence angle (JLCA) and joint line obliquity (JLO), were measured preoperatively and postoperatively, utilising standing and supine whole lower extremity anteroposterior, valgus and varus stress radiographs. Multiple linear regression analysis identified the factors affecting alignment changes, and a prediction model was developed. A method for applying this prediction model to preoperative planning was proposed. RESULTS: Preoperative JLCA on standing (preJLCA ), preoperative JLCA on 0° valgus stress radiograph (vgJLCA ), and preoperative JLO (preJLO) were significantly correlated with JLCA change (∆JLCA) (p < 0.001, p < 0.001, p = 0.006). The prediction model was estimated as ∆JLCA = 0.493 × (vgJLCA ) - 0.727 × (preJLCA ) + 0.189 × (preJLO) - 1.587 in. (R = 0.815, modified R = 0.646, p < 0.001). The proposed method resulted in a reduced overcorrection rate (p = 0.003) and an improved proportion of acceptable alignments (p = 0.013). CONCLUSION: PreJLCA , vgJLCA and preJLO can be used to estimate ∆JLCA. PreJLO was recently identified as a significant factor associated with additional alignment changes. Utilising the proposed preoperative planning and a prediction model with these factors shows promise in calibrating postoperative alignment after MOWHTO. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
目的：本研究旨在通过仅选择那些按照计划进行了精确的骨性矫正且矫正效果良好的患者，分析在准确的骨性矫正后导致术后对线改变的相关因素，并建立一种将显著因素纳入术前规划的方法。
方法：回顾性分析 2019 年 10 月至 2022 年 7 月间接受内侧开放楔形胫骨高位截骨术（MOWHTO）的 104 例连续患者，其中 61 例患者的骨性矫正效果良好。骨性矫正效果良好的主要标准是模拟内侧近段胫骨角（MPTA）与三维测量的实际术后 MPTA 之间的差异<1°。利用站立位和仰卧位下肢全长正位、外翻位和内翻位应力位 X 线片，测量术前和术后的关节线会聚角（JLCA）和关节线倾斜角（JLO）等影像学参数。多线性回归分析确定了影响对线改变的因素，并建立了预测模型。提出了一种将该预测模型应用于术前规划的方法。
结果：站立位时的术前 JLCA（preJLCA）、0°外翻位应力位 X 线片上的术前 JLCA（vgJLCA）和术前 JLO（preJLO）与 JLCA 改变（∆JLCA）显著相关（p<0.001，p<0.001，p=0.006）。预测模型估计为∆JLCA=0.493×（vgJLCA）-0.727×（preJLCA）+0.189×（preJLO）-1.587（R=0.815，调整 R ²=0.646，p<0.001）。所提出的方法导致过度矫正率降低（p=0.003），可接受对线比例提高（p=0.013）。
结论：preJLCA、vgJLCA 和 preJLO 可用于估计 ∆JLCA。preJLO 最近被确定为与额外对线改变相关的显著因素。利用所提出的术前规划和包含这些因素的预测模型，有望在 MOWHTO 术后对线方面进行校准。
证据水平：三级，回顾性队列研究。
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