胫骨高位内侧开放截骨术后胫骨平台后倾角变化相关因素的探讨

Influencing factors of posterior tibial slope by opening wedge high tibial osteotomy

目的探讨导致胫骨高位内侧开放截骨术(OWHTO)后胫骨平台后倾角(PTS)发生改变的因素。方法回顾性分析2020年1月至2021年6月在福州市第二医院骨科57例行胫骨高位内侧开放截骨术(OWHTO)患者的临床资料。其中,男29例,女28例;年龄22~74(56.8±10.1)岁;身高1.4~1.8(1.6±0.1)m;体重43~104(68.7±10.8)kg。所有患者获得12个月以上随访。采用疼痛视觉模拟评分(VAS)、纽约特种外科医院膝关节评分(HSS)评价手术前后膝关节疼痛及术后关节功能状况。收集患者一般资料、手术相关资料(术前规划的矫正角度、术中实际撑开距离、手术前后患者的胫骨平台后倾角、胫骨近端内侧角、胫股冠状角)。通过多元线性回归分析探讨导致手术后PTS改变的因素。结果术后VAS评分较术前降低(t=21.64,P<0.001);HSS评分较术前提高(t=18.92,P<0.001)。利用多元线性回归比较各参数与PTS变化的相关性,结果显示,各参数对PTS变化影响程度的占比为50%。术后PTS改变程度与术前PTS值,及术中撑开距离显著相关(P<0.05),术中撑开距离越大,术后PTS发生的改变的可能越大(β=0.492)。术前PTS越大,术后PTS发生的改变的越小(β=-0.528)。其余测量参数均与术后PTS非显著相关(P>0.05)。结论OWHTO手术可有效缓解关节疼痛、纠正膝关节畸形,改善关节功能状况。在非刻意调整PTS的情况下,术中撑开距离、术前PTS的大小与术后PTS变化相关。术中撑开距离越大,术后PTS改变的可能性越大。当术前PTS越小,术后PTS改变的可能性愈大。

Objective To investigate the factors contributing to changes in the posterior tibial slope(PTS)after opening wedge high tibial osteotomy(OWHTO).Methods A total of 57 patients who received OWHTO in Orthopedics Department of Fuzhou Second Hospital of Xiamen University from January 2020 to June 2021,were retrospectively reviewed.There were 29 males,28 females;age was 22-74(56.8±10.1)years;height 1.4-1.8(1.6±0.1)m;weight 43-104(68.7±10.8)kg.All patients received more than 12 months of follow-up.The pain visual analogue scale(VAS)and the Hospital for Special Surgery(HSS)were used to evaluate knee pain and joint function.General patient data surgery-related data(preoperative planned correction angle,actual degree of osteotomy opening,posterior tibial slope,medial proximal tibial angle,and coronal tibiofemoral angle before and after surgery)were collected.Factors leading to changes in PTS before and after surgery were explored by multiple linear regression analysis.Results VAS scores were lower than preoperative scores(t=21.64,P<0.001).HSS scores were higher than preoperative scores(t=18.92,P<0.001).The results of Multiple linear regression showed that the percentage of collected parameter's influence on the changes in PTS was 50%.The change of postoperative PTS was significantly correlated with preoperative PTS and the degree of osteotomy opening(P<0.05).The greater the degree of osteotomy opening,the greater the likelihood of postoperative PTS change(β=0.492).The greater of the preoperative PTS,the smaller the postoperative PTS change(β=-0.528).The other factors were non-significantly correlated with postoperative PTS(P>0.05).Conclusion OWHTO can effectively relieve joint pain,correct knee deformity,and improve joint functional.Without intentionally changing the PTS,the preoperative PTS is significantly correlated with preoperative PTS and the degree of osteotomy opening.The greater the degree of osteotomy opening,the greater the likelihood of postoperative PTS change.The greater the preoperative PTS,the less likely the PTS will change postoperatively.