BACKGROUND High tibial osteotomy(HTO)is a well-known procedure for the correction of knee varus.The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using tw...BACKGROUND High tibial osteotomy(HTO)is a well-known procedure for the correction of knee varus.The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques:acute opening wedge correction using a plate and gradual correction with a monolateral external fixator.AIM To compare of the radiological results of two different techniques:acute opening wedge correction(a plate and screw)and gradual correction(external fixator).METHODS A total of 43 patients with plates and 36 patients with external fixators were included.All patients had moderate uniplanar varus deformities.We measured radiographic parameters,including the mechanical axis deviation(MAD),medial proximal tibial angle(MPTA),Caton-Deschamps Index(CDI),posterior proximal tibial angle,and joint line obliquity angle(JLOA).The accuracy of MAD correction was calculated based on a correction goal of neutral or overcorrection for medial compartment arthritis.RESULTS Demographics including age,body mass index,sex,and preoperative deformities were similar between the groups.The MAD significantly improved from 23.6 mm medial to the midline(SD=8.2 mm)to 6.9 mm lateral to the midline(SD=5.4 mm)(P<0.001).The accuracy of MAD correction did not differ between the groups and was 96.1%(SD=8.1%)in the plate group and 98.2%(SD=5.2%)in the external fixator group(P=0.18).The MPTA significantly improved from 83.9°(SD=2.9°)to 90.9°(SD=3.3°)(P<0.001),and the change was similar between the groups.Differences were noted in patella height,with a CDI change of-19.2%(SD=13.7%)and 3.1%(SD=8.0%)for the plate and external fixator groups,respectively(P<0.001).The change in JLOA was 1.6 degrees(SD=1.1 degrees)and 0.9 degrees(SD=0.9 degrees)for the plate and external fixator groups,respectively(P=0.04).CONCLUSION Reliable correction of moderate varus alignment was achieved with both the acute opening wedge technique with a plate and the gradual monolateral external fixator technique.The patellar height decreased with the open wedge plate technique.Joint line obliquity decreased to a greater degree with the open wedge plate technique,perhaps as a result of medial collateral ligament release.The appropriate technique should be selected based on surgeon and patient preferences;however,external fixation may be a better choice when the preservation of patellar height is deemed important.展开更多
背景:传统全膝关节置换因其复杂的髓内定位技术、过度依赖术者经验截骨而广为诟病,在3D打印技术辅助下行全膝关节置换能够更加精确的进行定位、截骨。目的:比较在3D打印技术辅助下行全膝关节置换治疗膝内翻畸形与传统治疗方案临床疗效...背景:传统全膝关节置换因其复杂的髓内定位技术、过度依赖术者经验截骨而广为诟病,在3D打印技术辅助下行全膝关节置换能够更加精确的进行定位、截骨。目的:比较在3D打印技术辅助下行全膝关节置换治疗膝内翻畸形与传统治疗方案临床疗效的差异。方法:收集接受初次单侧全膝关节置换治疗膝内翻畸形患者的临床资料34例,采用随机数字表法分为2组,每组17例。其中一组患者在3D打印截骨导板辅助下行全膝关节置换治疗(3D打印组);另外一组患者接受传统全膝关节置换治疗(常规组)。记录2组患者出血量(包括术中出血量及术后引流量)、手术时间,关节置换后2周时美国特种外科医院(Hospital for Special Surgery,HSS)膝评分、膝关节活动度及股骨与胫骨机械轴夹角。结果与结论:(1)3D打印组关节置换后2周膝关节活动范围大于常规组,但差异无显著性意义(P=0.744);(2)3D打印组关节置换后2周HSS膝关节评分2组差异无显著性意义(P=0.532);(3)置换后股骨与胫骨机械轴夹角,2组差异无显著性意义(t=0.218,P=0.632);(4)3D打印组手术时间较常规组显著缩短(P=0.000);(5)3D打印组出血量较常规组显著减少(P=0.000);(6)结果表明,应用3D打印截骨导板辅助行全膝关节置换后2周膝关节活动范围、HSS评分及下肢力线恢复情况无显著差异,但具有手术时间短,出血量少,截骨更精确等优点,更适合于高龄、基础状态差、创伤承受能力小,要求迅速完成手术的患者。展开更多
目的:探讨膝骨关节炎(knee osteoarthritis,KOA)患者膝内翻畸形的影响因素。方法:纳入KOA患者237例,拍摄患者负重正位双下肢X线片,测量双下肢膝内翻角。两侧膝内翻角不一致时,记录角度较大者。从病历系统中提取患者的性别、年龄、文化...目的:探讨膝骨关节炎(knee osteoarthritis,KOA)患者膝内翻畸形的影响因素。方法:纳入KOA患者237例,拍摄患者负重正位双下肢X线片,测量双下肢膝内翻角。两侧膝内翻角不一致时,记录角度较大者。从病历系统中提取患者的性别、年龄、文化程度、体质量指数、Kellgren-Lawrence影像分级、KOA家族史、膝关节外伤史、病程等信息。采用美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分标准评价患者膝关节运动功能,记录HSS膝关节评分;设计调查问卷获取患者工作姿势、工作类型、排便姿势、爬山频次、饮酒史、吸烟史、是否进行规律的伸展运动、通勤方式、住房类型、有无服用钙补充剂及水果、蔬菜、肉类摄入量等信息。根据膝内翻角大小将纳入的患者分为膝内翻角正常组(膝内翻角<10°)和膝内翻畸形组(膝内翻角≥10°)。先对2组患者的相关信息进行单因素对比分析,然后对其中组间差异有统计学意义的因素进行多因素Logistic回归分析。结果:问卷调查收回有效问卷232份,最终纳入KOA患者232例。膝内翻角正常组121例,膝内翻畸形组111例。2组患者性别、年龄、体质量指数、Kellgren-Lawrence影像分级、病程、HSS膝关节评分、工作姿势、工作类型、排便姿势、爬山频次、是否进行规律的伸展运动、通勤方式、住房类型、有无服用钙补充剂的比较,组间差异均有统计学意义(χ^(2)=5.033,P=0.025;t=-3.197,P=0.002;t=-4.487,P=0.000;χ^(2)=5.426,P=0.020;t=-6.454,P=0.000;t=3.715,P=0.000;χ^(2)=5.320,P=0.021;χ^(2)=5.772,P=0.016;χ^(2)=5.188,P=0.023;χ^(2)=4.566,P=0.033;χ^(2)=5.110,P=0.024;χ^(2)=6.718,P=0.035;χ^(2)=13.113,P=0.001;χ^(2)=5.994,P=0.014);2组患者文化程度、KOA家族史、膝关节外伤史、饮酒史、吸烟史、水果摄入量、蔬菜摄入量、肉类摄入量的比较,组间差异均无统计学意义(χ^(2)=0.114,P=0.736;χ^(2)=0.983,P=0.321;χ^(2)=2.958,P=0.085;χ^(2)=1.662,P=0.197;χ^(2)=0.145,P=0.703;χ^(2)=0.982,P=0.322;χ^(2)=1.359,P=0.244;χ^(2)=0.145,P=0.703)。Logistic回归分析结果显示,年龄、体质量指数、Kellgren-Lawrence影像分级、工作姿势、排便姿势、爬山频次、不进行规律的伸展运动、通勤方式(步行)、住房类型(无电梯且4楼及以上)均是KOA患者膝内翻畸形的危险因素(β=0.375,P=0.031,OR=1.455;β=0.428,P=0.010,OR=1.534;β=0.501,P=0.007,OR=1.650;β=0.481,P=0.008,OR=1.618;β=0.349,P=0.039,OR=1.418;β=0.382,P=0.048,OR=1.465;β=0.391,P=0.037,OR=1.478;β=0.406,P=0.013,OR=1.501;β=0.413,P=0.001,OR=1.511),HSS膝关节评分是KOA患者膝内翻畸形的保护因素(β=-0.513,P=0.005,OR=0.599)。结论:年龄、体质量指数、Kellgren-Lawrence影像分级、工作姿势、排便姿势、爬山频次、不进行规律的伸展运动、通勤方式(步行)、住房类型(无电梯且4楼及以上)均是KOA患者膝内翻畸形的危险因素,HSS膝关节评分是KOA患者膝内翻畸形的保护因素。展开更多
文摘BACKGROUND High tibial osteotomy(HTO)is a well-known procedure for the correction of knee varus.The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques:acute opening wedge correction using a plate and gradual correction with a monolateral external fixator.AIM To compare of the radiological results of two different techniques:acute opening wedge correction(a plate and screw)and gradual correction(external fixator).METHODS A total of 43 patients with plates and 36 patients with external fixators were included.All patients had moderate uniplanar varus deformities.We measured radiographic parameters,including the mechanical axis deviation(MAD),medial proximal tibial angle(MPTA),Caton-Deschamps Index(CDI),posterior proximal tibial angle,and joint line obliquity angle(JLOA).The accuracy of MAD correction was calculated based on a correction goal of neutral or overcorrection for medial compartment arthritis.RESULTS Demographics including age,body mass index,sex,and preoperative deformities were similar between the groups.The MAD significantly improved from 23.6 mm medial to the midline(SD=8.2 mm)to 6.9 mm lateral to the midline(SD=5.4 mm)(P<0.001).The accuracy of MAD correction did not differ between the groups and was 96.1%(SD=8.1%)in the plate group and 98.2%(SD=5.2%)in the external fixator group(P=0.18).The MPTA significantly improved from 83.9°(SD=2.9°)to 90.9°(SD=3.3°)(P<0.001),and the change was similar between the groups.Differences were noted in patella height,with a CDI change of-19.2%(SD=13.7%)and 3.1%(SD=8.0%)for the plate and external fixator groups,respectively(P<0.001).The change in JLOA was 1.6 degrees(SD=1.1 degrees)and 0.9 degrees(SD=0.9 degrees)for the plate and external fixator groups,respectively(P=0.04).CONCLUSION Reliable correction of moderate varus alignment was achieved with both the acute opening wedge technique with a plate and the gradual monolateral external fixator technique.The patellar height decreased with the open wedge plate technique.Joint line obliquity decreased to a greater degree with the open wedge plate technique,perhaps as a result of medial collateral ligament release.The appropriate technique should be selected based on surgeon and patient preferences;however,external fixation may be a better choice when the preservation of patellar height is deemed important.
文摘背景:传统全膝关节置换因其复杂的髓内定位技术、过度依赖术者经验截骨而广为诟病,在3D打印技术辅助下行全膝关节置换能够更加精确的进行定位、截骨。目的:比较在3D打印技术辅助下行全膝关节置换治疗膝内翻畸形与传统治疗方案临床疗效的差异。方法:收集接受初次单侧全膝关节置换治疗膝内翻畸形患者的临床资料34例,采用随机数字表法分为2组,每组17例。其中一组患者在3D打印截骨导板辅助下行全膝关节置换治疗(3D打印组);另外一组患者接受传统全膝关节置换治疗(常规组)。记录2组患者出血量(包括术中出血量及术后引流量)、手术时间,关节置换后2周时美国特种外科医院(Hospital for Special Surgery,HSS)膝评分、膝关节活动度及股骨与胫骨机械轴夹角。结果与结论:(1)3D打印组关节置换后2周膝关节活动范围大于常规组,但差异无显著性意义(P=0.744);(2)3D打印组关节置换后2周HSS膝关节评分2组差异无显著性意义(P=0.532);(3)置换后股骨与胫骨机械轴夹角,2组差异无显著性意义(t=0.218,P=0.632);(4)3D打印组手术时间较常规组显著缩短(P=0.000);(5)3D打印组出血量较常规组显著减少(P=0.000);(6)结果表明,应用3D打印截骨导板辅助行全膝关节置换后2周膝关节活动范围、HSS评分及下肢力线恢复情况无显著差异,但具有手术时间短,出血量少,截骨更精确等优点,更适合于高龄、基础状态差、创伤承受能力小,要求迅速完成手术的患者。
文摘目的:探讨膝骨关节炎(knee osteoarthritis,KOA)患者膝内翻畸形的影响因素。方法:纳入KOA患者237例,拍摄患者负重正位双下肢X线片,测量双下肢膝内翻角。两侧膝内翻角不一致时,记录角度较大者。从病历系统中提取患者的性别、年龄、文化程度、体质量指数、Kellgren-Lawrence影像分级、KOA家族史、膝关节外伤史、病程等信息。采用美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分标准评价患者膝关节运动功能,记录HSS膝关节评分;设计调查问卷获取患者工作姿势、工作类型、排便姿势、爬山频次、饮酒史、吸烟史、是否进行规律的伸展运动、通勤方式、住房类型、有无服用钙补充剂及水果、蔬菜、肉类摄入量等信息。根据膝内翻角大小将纳入的患者分为膝内翻角正常组(膝内翻角<10°)和膝内翻畸形组(膝内翻角≥10°)。先对2组患者的相关信息进行单因素对比分析,然后对其中组间差异有统计学意义的因素进行多因素Logistic回归分析。结果:问卷调查收回有效问卷232份,最终纳入KOA患者232例。膝内翻角正常组121例,膝内翻畸形组111例。2组患者性别、年龄、体质量指数、Kellgren-Lawrence影像分级、病程、HSS膝关节评分、工作姿势、工作类型、排便姿势、爬山频次、是否进行规律的伸展运动、通勤方式、住房类型、有无服用钙补充剂的比较,组间差异均有统计学意义(χ^(2)=5.033,P=0.025;t=-3.197,P=0.002;t=-4.487,P=0.000;χ^(2)=5.426,P=0.020;t=-6.454,P=0.000;t=3.715,P=0.000;χ^(2)=5.320,P=0.021;χ^(2)=5.772,P=0.016;χ^(2)=5.188,P=0.023;χ^(2)=4.566,P=0.033;χ^(2)=5.110,P=0.024;χ^(2)=6.718,P=0.035;χ^(2)=13.113,P=0.001;χ^(2)=5.994,P=0.014);2组患者文化程度、KOA家族史、膝关节外伤史、饮酒史、吸烟史、水果摄入量、蔬菜摄入量、肉类摄入量的比较,组间差异均无统计学意义(χ^(2)=0.114,P=0.736;χ^(2)=0.983,P=0.321;χ^(2)=2.958,P=0.085;χ^(2)=1.662,P=0.197;χ^(2)=0.145,P=0.703;χ^(2)=0.982,P=0.322;χ^(2)=1.359,P=0.244;χ^(2)=0.145,P=0.703)。Logistic回归分析结果显示,年龄、体质量指数、Kellgren-Lawrence影像分级、工作姿势、排便姿势、爬山频次、不进行规律的伸展运动、通勤方式(步行)、住房类型(无电梯且4楼及以上)均是KOA患者膝内翻畸形的危险因素(β=0.375,P=0.031,OR=1.455;β=0.428,P=0.010,OR=1.534;β=0.501,P=0.007,OR=1.650;β=0.481,P=0.008,OR=1.618;β=0.349,P=0.039,OR=1.418;β=0.382,P=0.048,OR=1.465;β=0.391,P=0.037,OR=1.478;β=0.406,P=0.013,OR=1.501;β=0.413,P=0.001,OR=1.511),HSS膝关节评分是KOA患者膝内翻畸形的保护因素(β=-0.513,P=0.005,OR=0.599)。结论:年龄、体质量指数、Kellgren-Lawrence影像分级、工作姿势、排便姿势、爬山频次、不进行规律的伸展运动、通勤方式(步行)、住房类型(无电梯且4楼及以上)均是KOA患者膝内翻畸形的危险因素,HSS膝关节评分是KOA患者膝内翻畸形的保护因素。
