导航辅助外翻应力法对避免胫骨高位截骨过度矫正的作用

Navigation-assisted valgus stress method can avoid over correction of high tibial osteotomy

目的探讨导航辅助外翻应力法在避免胫骨高位截骨术(high tibial osteotomy,HTO)下肢机械轴过度矫正中的作用。方法回顾性分析海军军医大学第一附属医院于2020年1月至2022年3月采用HTO治疗膝关节内侧间室疼痛的骨关节炎患者资料,根据术中确认力线的方式分为计算机导航辅助外翻应力HTO组(简称导航组)和常规力线杆透视HTO组(简称常规组)。导航组28例,男10例、女18例,年龄(54.4±9.1)岁(范围41~73岁),体质指数(26.1±3.3)kg/m^(2)(范围19.8~35.2 kg/m^(2));常规组30例,男13例、女17例,年龄(56.9±8.5)岁(范围40~70岁),体质指数(25.7±4.0)kg/m^(2)(范围19.2~32.9 kg/m^(2))。测量两组术前和末次随访时的机械股骨胫骨角(mechanical femorotibial angle,mFTA)、关节线汇聚角(joint line convergence angle,JLCA)、胫骨近端内侧角(medial proximal tibia angle,MPTA),同时采用Lysholm评分和特种外科医院(Hospital for Special Surgery,HSS)评分评价术后功能。结果导航组和常规组患者均获得随访,随访时间分别为(21.3±8.7)个月和(22.5±7.6)个月,差异无统计学意义(t=0.53,P=0.596)。导航组与常规组术后mFTA分别为2.2°±1.7°和3.5°±2.1°,差异有统计学意义(t=2.53,P=0.014);两组机械轴矫正量ΔmFTA(9.6±3.3和11.4±3.2)和骨性矫正量ΔMPTA(8.6±2.9和10.5±2.6),差异均有统计学意义(t=2.09,P=0.041;t=2.58,P=0.012),而ΔJLCA(0.9±1.3和1.0±1.6)差异无统计学意义(t=0.32,P=0.753)。导航组中矫正不足9例(32%)、满意力线17例(61%)、过度矫正2例(7%),常规组中矫正不足5例(17%)、满意力线13例(43%)、过度矫正12例(40%);两组力线矫正分布的差异有统计学意义(P=0.012);导航组过度矫正率低于常规组(7%比40%,P=0.005)。导航矫正机械轴与ΔmFTA的组内相关系数为0.787。术前及末次随访时两组Lysholm评分和HSS评分比较差异均无统计学意义(P>0.05),两组末次随访时较术前增加,差异均有统计学意义(P<0.05)。结论导航辅助外翻应力法HTO方法可靠,可以更加精确地获得目标力线,降低过度矫正的发生率。

Objective To explore the role of navigation-assisted valgus stress method in avoiding excessive correction of lower limb mechanical axis after high tibial osteotomy(HTO).Methods A retrospective study was carried out on osteoarthritis(OA)patients who were treated with HTO for medial compartment pain of knee from January 2020 to March 2022 in the Department of Joint Surgery,Shanghai Changhai Hospital,the First Affiliated Hospital of Naval Medical University.According to the different ways of confirming alignment during operation,they were divided into computer navigation assisted valgus stress HTO group(referred to as navigation group)and traditional rod fluoroscopy HTO group(referred to as traditional group).There were 28 patients in the navigation group,10 males and 18 females,with age of 54.4±9.1 years(range,41-73 years)and body mass index of 26.1±3.3 kg/m^(2)(range,19.8-35.2 kg/m^(2));There were 30 patients in the traditional group,13 males and 17 females,aged 56.9±8.5 years(range,40-70 years),with a body mass index of 25.7±4.0 kg/m^(2)(range,19.2-32.9 kg/m^(2)).Measuring the mechanical femoral tibial angle(mFTA),joint line convergence angle(JLCA),medial proximal tibial angle(MPTA),Lysholm score and Hospital for Special Surgery(HSS)score before operation and at the last follow-up of the two groups,and conduct statistical analysis.Results Both groups were followed up.The follow-up time of navigation group and traditional group was 21.3±8.7 months and 22.5±7.6 months,respectively,with no significant difference(t=0.53,P=0.596).There were significant differences between the two groups in the amount of mechanical axis correction(ΔmFTA)and the amount of bone correction(ΔMPTA)(t=2.09,P=0.041;t=2.58,P=0.012),while there was no significant difference inΔJLCA(t=0.32,P=0.753).In the navigation group,there were 9 cases(32%)of undercorrection,17 cases(61%)with acceptable alignment,and 2 cases(7%)with over correction,while in the traditional group,there were 5 cases(17%)with under correction,13 cases(43%)with acceptable alignment,and 12 cases(40%)with over correction.There was significant difference in the distribution rate of alignment between the two groups(P=0.012),and the rate of overcorrection in the navigation group was significantly lower than that in the control group(7%vs.40%,P=0.005).The intra group correlation coefficient between the navigation correction mechanical axis andΔmFTA was 0.787.There was no significant difference in Lysholm score and HSS score between the two groups before and after surgery(all P>0.05),and they were significantly improved after operation(all P<0.05).Conclusion Navigation-assisted valgus stress method HTO is reliable,which can accurately achieve the target alignment,reduce the incidence of over correction,and obtain good clinical results.