胫骨高位截骨术后矫形角度变化的分析

Analysis of Correction Angle Changes after High Tibial Osteotomy

目的调查随时间推移,内侧开放楔形胫骨高位截骨术(open-wedge high tibial osteotomy,OWHTO)术后矫形角度是否丢失,并确定哪些因素与其相关。方法回顾性研究2018年5月至2020年10月期间于新疆医科大学附属中医医院进行OWHTO的患者,共纳入40例(45膝)患者,男15例,女25例;平均年龄为(55.4±11.86)岁。测量患者术前、术后、术后1年时的髋-膝-踝角(hip-knee-ankle angle,HKA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)、关节线会聚角(joint line convergence angle,JLCA)、胫骨后倾角(posterior tibial slope,PTS)及Caton指数;比较患者术前、术后1年的西安大略和麦克马斯特大学骨关节炎指数(western Ontario and McMaster universities osteoarthritis index,WOMAC)和美国膝关节协会(American knee society,AKS)评分。结果术后患者均获13~28个月随访,平均随访(18.7±7.54)个月。HKA由术前(-8.00±3.17)°矫正至术后3 d(2.56±2.61)°,术后1年为(1.66±2.89)°;术前及术后3 d、1年组间比较差异有统计学意义(P<0.05)。JLCA由术前(2.54±1.43)°变化至术后3 d(2.54±1.94)°,术后1年为(2.38±1.60)°;PTS由术前(7.81±5.05)°变化至术后3 d(6.98±4.71)°,术后1年为(8.34±4.83)°;JLCA与PTS组间比较,差异均无统计学意义(P>0.05)。以术后3 d同术后1年相比,HKA变化大于1°为界,分为变化组和不变组,对于术前JLCA和术后PTS进行比较,组间差异均无统计学意义(P>0.05)。结论在OWHTO病例中,约49%的病例在1年的随访中显示矫形角度丢失>1°,但未发现与其相关的影响因素。

Objective To investigate whether correction angles lost over time after medial open-wedge high tibial osteotomy(OWHTO)and to determine which factors are related.Methods A total of 40 patients(45 knees)with OWHTO at Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University from May 2018 to October 2020 were retrospectively reviewed,including 15 males and 25 females.The average age was(55.40±11.86)years.We measured the hip-knee-ankle angle(HKA),medial proximal tibial angle(MPTA),joint line convergence angle(JLCA),posterior tibial slope(PTS)and Caton index before,after,and 1 year after surgery.The scores of Western ontario and McMaster universities osteoarthritis index(WOMAC)and American knee society(AKS)of patients before and 1 year after surgery were compared.Results All patients were followed up for 13 to 28 months,with an average of(18.7±7.54)months.HKA was corrected from(-8±3.17)°before surgery to(2.56±2.61)°3 days after surgery,and(1.66±2.89)°1 year after surgery.There were significant differences in preoperative,postoperative 3 days and 1 year after surgery(P<0.05).JLCA ranged from(2.54±1.43)°preoperatively to(2.54±1.94)°3 days after surgery,and(2.38±1.60)°1 year after surgery.PTS ranged from(7.81±5.05)°preoperatively to(6.98±4.71)°3 days after surgery,and(8.34±4.83)°1 year after surgery.The difference between the JLCA and PTS groups was not considered statistically significant(P>0.05).Compared with 1 year after operation,HKA changed more than 1°as the boundary,they were divided into change group and unchanged group.There was no significant difference in preoperative JLCA and postoperative PTS between groups(P>0.05).Conclusion About 49%of OWHTO cases show a loss of correction angle>1°at 1-year follow-up,but no associated influencing factors has been found.