患者特异性截骨导板提高内侧开放楔形高位胫骨截骨术的准确性：一项回顾性病例对照研究。
Patient-specific cutting guides increase accuracy of medial opening wedge high tibial osteotomy procedure: A retrospective case-control study.
作者信息
Fayard Jean-Marie, Saad Maxime, Gomes Lucas, Kacem Sami, Abid Hichem, Vieira Thais D, Lambrey Pierre-Jean, Ollivier Matthieu, Thaunat Mathieu
机构信息
Ramsay Santé, Hôpital Privé Jean Mermoz-Centre Orthopedique Santy, FIFA Medical Center of Excellence Lyon France.
Department of Orthopedics and Traumatology, Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital Institute for Locomotion Marseille France.
出版信息
J Exp Orthop. 2024 Mar 19;11(1):e12013. doi: 10.1002/jeo2.12013. eCollection 2024 Jan.
PURPOSE
To compare the accuracy of patient-specific guides (PSCG) to the standard technique in medial open-wedge high tibial osteotomy (OWHTO). Secondary objectives were to evaluate factors that could influence accuracy and to compare the complication rate and operating time for both procedures.
METHODS
A retrospective analysis of prospective collected data was performed. Between March 2011 and May 2018, 49 patients with isolated medial knee osteoarthritis who were operated for OWHTO using PSCG and 38 patients using the standard technique were included. Preoperative and postoperative deformities were evaluated on long leg radiographs by measuring the mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, hip knee ankle angle (HKA), and joint line convergence angle. Pre- and postoperative posterior tibial slope was also evaluated. Accuracy was evaluated by analysing the difference between the preoperative planned and the actual postoperative HKA. Operating time and complication rate were also recorded in both groups.
RESULTS
The mean preoperative HKA was 173.4° (±3.1°) in the PSCG group and 173.3° (±2.4°) in the standard group ( = 0.8416). Mean planned HKA were 182.8° (±1.1°) and 184.0° (±0°) respectively for the PSCG and the standard group. Mean postoperative HKA were 181.9° (±1.9°) and 182.6° (±3.1°) respectively for the PSCG and the standard group. An accuracy of ±2° in the HKA was achieved in 44 (90%) in the PSCG group and 24 (65%) in the standard group ( = 0.006). The probability of achieving a HKA accuracy was four times higher for patients in the PSCG group (odds ratio [OR] = 4.06, [1.1; 15.3], = 0.038). Also, higher preoperative Ahlback grade was associated with precision, all other parameters being equal (OR = 4.2, [0.13; 0.97], = 0.04).
CONCLUSION
In this study, the PSCG technique was significantly more accurate for achieving the planned HKA in OWHTO. Complication rates and operating times were comparable between groups.
LEVEL OF EVIDENCE
Level IV, case-control study.
目的
比较患者特异性导板（PSCG）与标准技术在内侧开放楔形高位胫骨截骨术（OWHTO）中的准确性。次要目的是评估可能影响准确性的因素，并比较两种手术的并发症发生率和手术时间。
方法
对前瞻性收集的数据进行回顾性分析。纳入2011年3月至2018年5月期间因OWHTO接受手术的49例孤立性内侧膝关节骨关节炎患者，其中49例使用PSCG，38例使用标准技术。通过测量机械性胫骨近端内侧角、机械性股骨远端外侧角、髋膝踝角（HKA）和关节线汇聚角，在长腿X线片上评估术前和术后畸形情况。还评估了术前和术后的胫骨后倾。通过分析术前计划的和实际术后HKA之间的差异来评估准确性。记录两组的手术时间和并发症发生率。
结果
PSCG组术前平均HKA为173.4°（±3.1°），标准组为173.3°（±2.4°）（P = 0.8416）。PSCG组和标准组的平均计划HKA分别为182.8°（±1.1°）和184.0°（±0°）。PSCG组和标准组术后平均HKA分别为181.9°（±1.9°）和182.6°（±3.1°）。PSCG组44例（90%）的HKA准确性达到±2°，标准组24例（65%）达到（P = 0.006）。PSCG组患者达到HKA准确性的概率是标准组患者的四倍（优势比[OR]=4.06，[1.1；15.3]，P = 0.038）。此外，在所有其他参数相同的情况下，术前Ahlback分级越高与精度相关（OR = 4.2，[0.13；0.97]，P = 0.04）。
结论
在本研究中，PSCG技术在OWHTO中实现计划的HKA方面明显更准确。两组之间的并发症发生率和手术时间相当。
证据水平
IV级，病例对照研究。
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