胫骨高位截骨对胫骨近端解剖形态的影响

Change of anatomic configuration of proximal tibia following high tibial osteotomy

[目的]测量胫骨高位截骨术后胫骨近端解剖形态，并与术前比较，探讨其变化的临床意义。[方法]2001—2005年，35例（59膝）因膝关节内侧室骨性关节炎接受胫骨高位截骨术患者的完整影像学资料，在术前、术后标准正侧位X线片中测量：胫骨角；胫骨后倾角度；胫骨近端关节面外移；关节线高度。所得资料采用配对t检验进行统计学分析，以P〈0．01为差异有显著性意义。[结果]胫骨角术前平均为99．1°±4．3°，术后平均为91．1°±3．8°；胫骨后倾角度术前平均为8．9°±2．6°，术后平均为5．0°±2．3°；胫骨近端关节面外移术前平均为（46．2±3．6）％，术后平均为（53．1±3．9）％；关节线高度术前平均（41．2±3．6）mm。术后平均（38．0±3．2）mm。手术前后差异均有显著性意义（P〈0．01）。[结论]胫骨近端解剖形态在胫骨高位截骨术后会发生明显变化，如胫骨角变小，后倾角度变小，胫骨近端关节面外移，关节线高度相对下降等，将对转行全膝关节置换术产生不良影响。

[ Objective ] To measure the change of anatomic configuration of proximal tibial after high tibial osteotomy and probe its clinical consequences. [Method] From 2001 to 2005, there were 59 knees of 35 patients with medial unicompartmental osteoarthritis treated with closing-wedge high tibial osteotomy. Anatomic configuration of proximal tibia were measured both pre and postoperatively on radiographs. They included posterior slope angle of proximal tibia, tibial angle, lateral shift of articular surface of proximal tibial and level of the joint line. The alteration of the above features was calculated and analyzed statistically with paired t test. [ Result] The mean tibial posterior slope angle were （ 8. 9°± 2. 6° ） preoperatively and （ 5.0°± 2. 3° ） postoperatively. The tibial posterior slope angle was averagely decreased about （3.9°± 1.7°）. Tibial angle were （99. 1°± 4. 3°） and （91.1°± 3.8°） before and after high tibial osteotomy respectively. Lateral shift of articular surface of proximal tibial were （46. 2 ± 3. 6） % and （53. 1 ± 3. 9） % in pre and postopratively. Level of joint line was （41.2 ± 3.6） mm and （ 38. 0 ± 3.2 ） mm in pre and postopratively. Statistical analysis indicated that there was significant difference of posterior slope angle or tibial angle or lateral shift of articular surface of proximal tibial or level of joint line between pre and post operative （ P 〈0. 01 ） [ Conclusion] The anatomic configuration of proximal tibial will change after high tibial osteotomy. These changes may exert negative effect on the results of total knee arthroplasty after high tibial osteotomy. Thorough understanding of the causes and consequences of these changes helps refining the techniques of high tibial osteotomy and preoperative planning of total knee arthroplasty if it is needed.