BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to pat...BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.展开更多
Objective:To observe the clinical efficacy and advantages of 3D printed patient-specific instrumentation(PSI)assisted distal tibial tuberosity-high tibial osteotomy in the treatment of medial compartment knee osteoart...Objective:To observe the clinical efficacy and advantages of 3D printed patient-specific instrumentation(PSI)assisted distal tibial tuberosity-high tibial osteotomy in the treatment of medial compartment knee osteoarthritis.Methods:75 patients with medial compartment knee osteoarthritis were included in the study performed DTT-HTO in our hospital from August 2017 to August 2019.The patients were divided into the PSI group(n=39)and conventional group(n=36)According to whether PSI was used in surgery.The differences of lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time,weight bearing line(WBL),Posterior tibial slope(PTS)and Caton-Deschamps index(CDI)were compared between the two groups.Visual analogue scale(VAS)scores and Hospital for Special Surgery(HSS)scores were recorded to evaluate knee pain and function before surgery and after surgery at 3 months and 12 months.Results:All 75 patients were followed up for more than 12 months,the ranged from 12-26(18.74±6.21)months.Three lateral cortical fractures in the conventional group and no fracture in PSI group.The lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time in PSI group were lower than those in conventional group(p敿0.05).WBL in two groups were significantly improved after surgery(p敿0.05),and PTS,CDI were no statistically improved after surgery(p>0.05).While there was no statistically significant difference with WBL,PTS and CDI between two groups(p>0.05).At 1 months,3 months and 12 months after surgery;VAS and HSS scores in both groups were significantly improved compared with that before surgery(p0.05),and were no statistically significant difference between two groups.Conclusion:3D printed patient-specific instrumentation assisted DTT-HTO has significant clinical efficacy,and effectively standardized surgical procedures,meanwhile reduced the time of intraoperative X-ray exposure,intraoperative blood loss and risk of lateral cortical fracture.展开更多
目的在膝内侧间室骨关节炎临床治疗过程中采取两种截骨术(腓骨截骨、内侧开放性楔形胫骨高位截骨),研究比较其临床治疗。方法选取2021年1月—2022年1月南通市第二人民医院所治疗的40例膝内侧间室骨关节炎患者,根据手术治疗方案将其均分...目的在膝内侧间室骨关节炎临床治疗过程中采取两种截骨术(腓骨截骨、内侧开放性楔形胫骨高位截骨),研究比较其临床治疗。方法选取2021年1月—2022年1月南通市第二人民医院所治疗的40例膝内侧间室骨关节炎患者,根据手术治疗方案将其均分为对照组(采取腓骨截骨术进行治疗,20例)与观察组(采取内侧开放性楔形胫骨高位截骨进行治疗,20例),研究观察两种截骨术的临床疗效。结果与对照组相比,观察组失血量较多[(327.62±115.84)mL vs(251.28±84.44)mL],差异有统计学意义(t=2.382,P<0.05);观察组血红蛋白变化量较多,差异有统计学意义(P<0.05);观察组术后16 h的视觉模拟评估量表(Visual Analogue Scale,VAS)分数较低[(1.32±0.57)分vs(1.86±0.97)分],差异有统计学意义(t=2.147,P<0.05);同时较之治疗前,两组患者治疗后膝关节功能(Hospital for special surgery,HSS)分数与骨性关节炎(Weern Otario and Mcmaster Universities Osteoarthritis,WOMAC)分数均更高,差异有统计学意义(P<0.05)。两组手术治疗时间、止血带使用时间、术后8 h与24 h的VAS分数、治疗前后HSS分数与WOMAC分数比较,差异无统计学意义(P>0.05)。结论与腓骨截骨术相比,内侧开放性楔形胫骨高位截骨治疗膝内侧室骨关节炎效果更佳。内侧开放性楔形胫骨高位截骨能够减轻术后疼痛感,值得推荐。展开更多
文摘BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.
基金Young Teacher Project of Basic Scientific Research in Beijing University of Chinese Medicine(No.2019-JYB-JS-178)。
文摘Objective:To observe the clinical efficacy and advantages of 3D printed patient-specific instrumentation(PSI)assisted distal tibial tuberosity-high tibial osteotomy in the treatment of medial compartment knee osteoarthritis.Methods:75 patients with medial compartment knee osteoarthritis were included in the study performed DTT-HTO in our hospital from August 2017 to August 2019.The patients were divided into the PSI group(n=39)and conventional group(n=36)According to whether PSI was used in surgery.The differences of lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time,weight bearing line(WBL),Posterior tibial slope(PTS)and Caton-Deschamps index(CDI)were compared between the two groups.Visual analogue scale(VAS)scores and Hospital for Special Surgery(HSS)scores were recorded to evaluate knee pain and function before surgery and after surgery at 3 months and 12 months.Results:All 75 patients were followed up for more than 12 months,the ranged from 12-26(18.74±6.21)months.Three lateral cortical fractures in the conventional group and no fracture in PSI group.The lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time in PSI group were lower than those in conventional group(p敿0.05).WBL in two groups were significantly improved after surgery(p敿0.05),and PTS,CDI were no statistically improved after surgery(p>0.05).While there was no statistically significant difference with WBL,PTS and CDI between two groups(p>0.05).At 1 months,3 months and 12 months after surgery;VAS and HSS scores in both groups were significantly improved compared with that before surgery(p0.05),and were no statistically significant difference between two groups.Conclusion:3D printed patient-specific instrumentation assisted DTT-HTO has significant clinical efficacy,and effectively standardized surgical procedures,meanwhile reduced the time of intraoperative X-ray exposure,intraoperative blood loss and risk of lateral cortical fracture.
文摘目的在膝内侧间室骨关节炎临床治疗过程中采取两种截骨术(腓骨截骨、内侧开放性楔形胫骨高位截骨),研究比较其临床治疗。方法选取2021年1月—2022年1月南通市第二人民医院所治疗的40例膝内侧间室骨关节炎患者,根据手术治疗方案将其均分为对照组(采取腓骨截骨术进行治疗,20例)与观察组(采取内侧开放性楔形胫骨高位截骨进行治疗,20例),研究观察两种截骨术的临床疗效。结果与对照组相比,观察组失血量较多[(327.62±115.84)mL vs(251.28±84.44)mL],差异有统计学意义(t=2.382,P<0.05);观察组血红蛋白变化量较多,差异有统计学意义(P<0.05);观察组术后16 h的视觉模拟评估量表(Visual Analogue Scale,VAS)分数较低[(1.32±0.57)分vs(1.86±0.97)分],差异有统计学意义(t=2.147,P<0.05);同时较之治疗前,两组患者治疗后膝关节功能(Hospital for special surgery,HSS)分数与骨性关节炎(Weern Otario and Mcmaster Universities Osteoarthritis,WOMAC)分数均更高,差异有统计学意义(P<0.05)。两组手术治疗时间、止血带使用时间、术后8 h与24 h的VAS分数、治疗前后HSS分数与WOMAC分数比较,差异无统计学意义(P>0.05)。结论与腓骨截骨术相比,内侧开放性楔形胫骨高位截骨治疗膝内侧室骨关节炎效果更佳。内侧开放性楔形胫骨高位截骨能够减轻术后疼痛感,值得推荐。
