胫骨高位外翻截骨并截骨远端前置内移术后胫骨内旋

Tibial internal rotation after high tibial osteotomy combined with anteromedial transfer of the distal fragment

目的观察胫骨高位外翻截骨并截骨远端前置内移术后的胫骨扭转角和足前进角的变化,探讨胫骨内旋对膝关节生物力学的影响及临床意义。方法膝内翻骨性关节炎并髌股关节炎患者24例(30膝)行胫骨高位外翻截骨并截骨远端前置内移术,男5例7膝,女19例23膝;年龄49～55岁,平均53岁。分别于术前和术后6个月～2年以足印迹法测量患侧足前进角,同时于术前和术后行CT扫描,测量患侧胫骨扭转角。采用t检验对术前、术后两组数据进行统计学分析。结果测量数据显示术前患侧足前进角为8.95°±2.99°,术后6个月时为-2.23°±4.11°;术前胫骨扭转角为33.77°±8.12°,术后为21.27°±8.48°。统计学分析显示足前进角和胫骨扭转角手术前、后差异有统计学意义(P<0.05)。术后胫骨扭转角比术前减小12.50°±2.60°,术后足前进角比术前减小11.08°±2.59°,两者比较差异无统计学意义(P>0.05)。结论胫骨高位外翻截骨并截骨远端前置内移术使胫骨内旋和足前进角减小,影响手术的效果及骨性关节炎病情的进展。

Objective To evaluation high tibial osteotomy combined with anteromedial transfer of the distal fragment for the treatment of medial and patellofemoral compartmental osteoarthritis of the varus knee. Methods High tibial osteotomy was performed in 30 knees of 24 patients with medial and patellofemoral compartmental osteoarthritis of the varus knee, which was combined with anteromedial transfer of the distal fragment. The patients included 5 males （7 knees）, 19 females （23 knees）, with the mean age 53 years （range, 49-55 years）. All patients were followed-up with footprints to assess the foot progression angle preoperatively and at 6 months to 2 years after the osteotomy. Tibial torsion of these subjects was nleasured by computerized tomography preoperatively and after the osteotomy. The statistical evaluation was carried out by the paired t test. Results The foot progression angle was 8.95°±2.99° preoperatively, and -2.23°±4.11° postoperatively during walking. The tibial torsion was 33.77°±8.12° preoperatively and 21.27°±8.48° after the osteotomy. The statistical evaluation showed foot progression angle and tibial torsion preoperative were significant difference from those postoperative （P〈 0.05）. Measure of foot progression angle and tibial torsion exhibited calf and foot internal rotating postoperatively. Tibial torsion decreased 12.50°±2.60° postoperatively, foot progression angle decreased 11.08°±2.59° posteratively. There were no significant difference between them（P〉 0.05）. This result revealed that the decrease of foot progression angle was equal with the decrease of tibial torsion postoperatively. Conclusion High tibial osteotomy combined with anteromedial transfer of the distal fragment may be the effective method for medial and patellofemoral compartmental osteoarthritis of the knee, but it would cause calf and foot internal rotation. The change of foot progression angle and tibial torsion can influence the effect of high tibial osteotomy. The magnitude of anteromedial transfer of the tibial tubercle must be individualized and be devised preoperatively. It is important to evaluate patellofemoral malalignment and to measure the magnitude of tibial internal rotation in operation.