Kamiya Tomoaki, Hamaoka Kodai, Ono Akira, Okada Yohei, Emori Makoto, Teramoto Atsushi
Department of Orthopaedic Surgery Sapporo Medical University School of Medicine Sapporo Hokkaido Japan.
J Exp Orthop. 2024 Jul 6;11(3):e12085. doi: 10.1002/jeo2.12085. eCollection 2024 Jul.
The purpose of this study was to assess the differences in lower limb global alignment and anatomical parameters of coronal whole-leg radiographs, which were generally used in preoperative planning for high tibial osteotomy (HTO), according to different weight-bearing standing positions.
Between April 2021 and December 2022, 176 patients (60 males and 116 females) were investigated. Full-weight-bearing coronal whole-leg radiographs were obtained with the patella centred on the femoral condyle. Patients were divided by Kellgren-Lawrence grade (KL-0, KL-I, KL-II and KL-III) and assessed in two standing positions: legs closed and legs spread. Patients with flexion contractures or those unable to stand with full weight bearing were excluded. The mechanical distal femoral angle, medial proximal tibial angle (MPTA), femorotibial angle, joint line convergence angle, percentage weight-bearing line (%WBL) and hip-knee-ankle angle (HKAA) were measured. The Student's test was used to compare the two standing positions. A value < 0.05 indicated a statistically significant difference.
The MPTAs of legs closed standing and legs spread standing were 84.9 ± 2.6° and 85.1 ± 2.4° in KL-0, 84.7 ± 2.0° and 84.9 ± 2.1° in KL-I and 85.0 ± 2.43° and 85.4 ± 2.4° in KL-II, respectively. There were statistically significant differences in the MPTA between the two standing positions in KL-0, KL-I and KL-II. In contrast, the %WBL and HKAA did not change regardless of the standing position. In the KL-III group, no statistical significance was observed for any of the anatomical parameters.
Several anatomical parameters were changed between the legs closed standing and the legs spread standing positions. It was suggested that the standing position should be taken into consideration in the planning for HTO.
Level IV, Case series with no comparison group.
本研究旨在评估在胫骨高位截骨术（HTO）术前规划中常用的冠状位全腿X线片的下肢整体对线和解剖参数在不同负重站立位之间的差异。
在2021年4月至2022年12月期间，对176例患者（60例男性和116例女性）进行了研究。获取髌骨位于股骨髁中心的全负重冠状位全腿X线片。患者根据凯尔格伦-劳伦斯分级（KL-0、KL-I、KL-II和KL-III）进行分组，并在两种站立位进行评估：双腿并拢和双腿分开。排除有屈曲挛缩或无法全负重站立的患者。测量机械性股骨远端角、胫骨近端内侧角（MPTA）、股胫角、关节线汇聚角、负重线百分比（%WBL）和髋-膝-踝角（HKAA）。采用学生t检验比较两种站立位。P值<0.05表示差异有统计学意义。
在KL-0中，双腿并拢站立和双腿分开站立时的MPTA分别为84.9±2.6°和85.1±2.4°；在KL-I中分别为84.7±2.0°和84.9±2.1°；在KL-II中分别为85.0±2.43°和85.4±2.4°。在KL-0、KL-I和KL-II中，两种站立位之间的MPTA存在统计学显著差异。相比之下，无论站立位如何，%WBL和HKAA均无变化。在KL-III组中，任何解剖参数均未观察到统计学意义。
双腿并拢站立和双腿分开站立位之间的几个解剖参数发生了变化。建议在HTO规划中应考虑站立位。
IV级，无比较组的病例系列。
