胫骨内侧高位截骨术中Miniaci法与力线杆定位法矫正下肢负重力线的精确性比较

Comparison of accuracy between image measuring rod localization method and Miniaci method for open wedge high tibial osteotomy

目的比较Miniaci法与力线杆定位法在胫骨内侧高位截骨术中力线矫正时的精确性。方法回顾性分析自2017-09—2019-06行关节镜下探查清理联合胫骨内侧高位截骨术治疗的45例膝关节内侧间室骨性关节炎合并内翻畸形,21例术中采用力线杆定位法(力线杆定位组),C型臂X线机透视下逐渐撑开截骨间隙使力线杆经过胫骨平台宽度的62.5%处;24例采用Miniaci法定位(Miniaci法定位组),采用负重位下肢全长X线片确定负重轴计算术中截骨撑开角度及高度。结果45例均获得随访,随访时间平均7(3~15)个月。与力线杆定位组比较,Miniaci法定位组手术时间明显更短,术中X线透视次数明显更少,术后胫股机械角、胫骨近端内侧角矫正程度更优,下肢负重力线矫正至可接受范围的比例明显更高,差异有统计学意义(P<0.05)。结论采用基于PACS影像的Miniaci法术前计划胫骨内侧高位截骨矫正角度比术中使用力线杆透视定位法更为精确,同时可减少术中透视时间,进而缩短手术时间。

Objective To compare the accuracy between Miniaci method and image measuring rod localization method in medial wedge high tibial osteotomy(HTO).Methods Forty-five patients with varus genu deformity combined with medial compartment osteoarthritis underwent arthroscopic cleaning combine with HTO from September 2017 to June 2019 were retrospectively analyzed.In twenty-one cases with image measuring rod localization method(the image localization group),under the fluoroscopy of C-arm X-ray machine,the osteotomy space was opened gradually to make the measuring rod pass the 62.5%point of the mediolateral tibial plateau width.In twenty-four cases with Miniaci method(the Miniaci method group),the angle and height of the osteotomy were determined on preoperative full-length lower limb radiographs.Results Fortyfive patients were all followed up,and the follow-up time was 3-15 months,average 7 months.In the Miniaci method group,the operation time and intraoperative fluoroscopy times were reduced significantly,the correction angles of mechanical medial proximal tibial angle and femorotibial angle,and the lower extremity weight bearing line correction to acceptable range in the Miniaci method group were better than those in the image localization group,the difference were statistically significant(P<0.05).Conclusion In medial HTO,correction based on the PACS using Miniaci method is more accurate than correction using the image measuring rod localization method,and it can also reduce the intraoperative fluoroscopy time,and then shorten the operation time.