开放楔形胫骨高位截骨术后胫骨平台后倾和胫骨扭转改变的影像学分析  

Radiological analysis of sagittal and torsional changes in the tibia following a medial open wedge high tibial osteotomy

作　　者：王兴山[1] 黄野[1] 柳剑[1] 刘刚 Wang Xingshan;Huang Ye;Liu Jian;Liu Gang(Department of Orthopaedic Surgery,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedic Surgery,Beijing Chaoyang Emergency Medical Center,Beijing 100122,China)

机构地区：[1]北京积水潭医院矫形骨科,100035 [2]北京朝阳急诊抢救中心矫形骨科,100122

出　　处：《中华外科杂志》2020年第6期435-440,共6页Chinese Journal of Surgery

摘　　要：目的探讨开放楔形胫骨高位截骨术后胫骨平台后倾和胫骨扭转的改变及其与胫骨近端冠状面矫正角度的相关性。方法本研究为前瞻性病例系列研究。筛选2019年3月至7月于北京朝阳急诊抢救中心矫形骨科行开放楔形胫骨高位截骨手术的患者纳入研究。手术均由同一医师完成,入组患者术前及术后3 d行X线及CT检查,分别测量胫骨股骨机械轴夹角(mFTA)、胫骨近端内侧角(MPTA)、胫骨平台后倾角(PTS)和胫骨扭转角(TTA)。采用配对样本t检验对手术前后各指标进行比较,采用Pearson相关系数法分析PTS和TTA的改变与MPTA矫正角度的相关性。结果研究共入组13例患者(19膝),男性9例(13膝),女性4例(6膝),年龄(39.4±14.4)岁(范围:20~60岁)。患者mFTA由术前(8.1±2.8)°矫正至术后(-1.4±1.6)°(t=14.819,P=0.000);MPTA由术前(81.1±2.4)°矫正至术后(90.4±3.4)°(t=-15.579,P=0.000);PTS术前为(79.6±3.2)°,术后为(76.8±3.1)°(t=9.709,P=0.000),患者术后mFTA、MPTA、PTS较术前差异均有统计学意义。手术前后TTA的差异无统计学意义[(28.2±1.5)°比(27.3±6.3)°,t=1.925,P=0.070]。术后PTS和TTA的改变与MPTA矫正角度间无相关性(r=0.384,P=0.105;r=0.321,P=0.181)。结论尽管术中采取了控制后倾的手术操作,开放楔形胫骨高位截骨术后PTS仍明显增大,而TTA较术前无明显改变,术后胫骨平台后倾和胫骨扭转的改变与胫骨近端冠状面矫正角度无关。Objective To investigate the sagittal and torsional changes in the tibia after a medial open wedge high tibial osteotomy(OWHTO)and their correlation with the corrective angle of proximal tibial coronal plane.Methods A prospective analysis was conducted on patients who underwent OWHTO at Department of Orthopaedic Surgery,Beijing Chaoyang Emergency Medical Center from March 2019 to July 2019.The operation were performed by the same surgeon.X-ray and CT were performed before and 3 days after the operation.The mechanical axis angle(mFTA),medial proximal tibial angle(MPTA),posterior tibial slope(PTS)and tibial torsion angle(TTA)were measured and compared by paired t-test.Pearson correlation coefficient was used to analyze the correlation between the changes of PTS and TTA and the correction angle of MPTA.Results A total of 13 patients(19 knees)were recruited.There were 9 males(13 knees)and 4 females(6 knees),aged(39.4±14.4)years(range:20 to 60 years).The mFTA improved from(8.1±2.8)degrees preoperatively to(-1.4±1.6)degrees postoperatively(t=14.819,P=0.000).The MPTA was changed from(81.1±2.4)degrees pre-operatively to(90.4±3.4)degrees postoperatively(t=-15.579,P=0.000).The PTS decreased from(79.6±3.2)degrees to(76.8±3.1)degrees(t=9.709,P=0.000).The differences of mFTA,MPTA and PTS were statistically significant.There was no significant difference in TTA between before and after operation((28.2±1.5)°vs.(27.3±6.3)°,t=1.925,P=0.070).There was no correlation between the correction angle of MPTA and the change of PTS and TTA(r=0.384,P=0.105;r=0.321,P=0.181).Conclusions Even if the intra-operative measures were used to control tibial slope,the PTS still increased significantly after OWHTO,while the TTA has no significant change.No correlation was seen between the change of sagittal and torsional and the corrective angle of proximal tibial coronal plane.

关 键 词：截骨术 胫骨 开放楔形胫骨高位截骨 后倾 扭转 

分 类 号：R687[医药卫生—骨科学]