开放楔形胫骨高位截骨术后膝关节的关节线收敛角影像学分析  

Imaging analysis on the joint line convergence angle of the knee joint after open-wedge high tibial osteotomy

作　　者：柳明忠[1] 施建辉[1] 谢俊杰 陈杰云[2] LIU Mingzhong;SHI Jianhui;XIE Junjie;CHEN Jieyun(Department of Orthopedics,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362100,China;Department of Imaging,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362100,China)

机构地区：[1]福建医科大学附属泉州第一医院骨科,福建泉州362100 [2]福建医科大学附属泉州第一医院影像科,福建泉州362100

出　　处：《中国医学物理学杂志》2021年第11期1381-1386,共6页Chinese Journal of Medical Physics

基　　金：泉州市科技计划项目(2018Z081)。

摘　　要：目的:研究开放楔形胫骨高位截骨术前仰卧位关节线收敛角(JLCA)与术后站立位JLCA的关系。方法:选取接受开放楔形胫骨高位截骨术治疗的84名膝关节内侧骨性关节炎患者,根据术前JLCA<4°(低JLCA组)和≥4°(高JLCA组)对患者进行分组。术前和术后1年分别测量膝关节活动度(ROM)、髋-膝-踝角(HKA)、负重线(WBL)比、美国膝关节协会(AKS)膝关节评分和功能评分、Lysholm膝关节评分,膝关节损伤骨性关节炎预后评分(KOOS)。结果:术前,高JLCA组的HKA、WBL比和潜在外侧松弛度明显小于低JLCA组(P<0.05)。高JLCA组的Kellgren和Lawrence评分高于低JLCA组(P<0.05)。两组之间在胫骨后倾斜度(TPS)、内侧近端胫骨角(MPTA)、总JLCA和关节线倾斜度(JLO)方面无明显差异(P>0.05)。高JLCA组的仰卧位JLCA、ΔJLCA、内翻JLCA、外翻JLCA和潜在内侧松弛度高于低JLCA组(P<0.05)。低JLCA组的ROM相比高JLCA组的运动范围大(P<0.05)。两组之间的任何临床评分均无明显差异(均P>0.05)。术后,在HKA、矫正误差、WBL比、TPS、MPTA骨矫正、总JLCA或JLO之间未发现明显差异(P>0.05)。但高JLCA组的矫正角和软组织矫正高于低JLCA组(P<0.05)。高JLCA组的术后JLCA、ΔJLCA、内翻JLCA和外翻JLCA高于低JLCA组(P<0.05)。低JLCA组的术后ROM高于高JLCA组(P<0.05)。两组之间的任何术后临床评分均无明显差异(P>0.05)。术前仰卧位JLCA与术后站立位JLCA相关(r=0.696,P<0.001)。结论:在控制术中JLCA时,术后冠状面排列不受JLCA改变和低JLCA组与高JLCA组软组织矫正差异的影响。然而,与目标冠状面排列相比,两组仍然存在过度矫正。Objective To study the relationship between the joint line convergence angle(JLCA)in the supine position before open-wedge high tibial osteotomy and JLCA in the standing position after operation.Methods A total of 84 patients receiving open-wedge high tibial osteotomy for medial knee osteoarthritis were selected and divided into low JLCA group(preoperative JLCA<4°)and high JLCA group(preoperative JLCA≥4°).Knee joint range of motion(ROM),hip-knee-ankle angle(HKA),weight-bearing line(WBL)ratio,American Knee Society(AKS)knee joint score and function score,Lysholm knee score,and knee injury and osteoarthritis outcome score(KOOS)were measured before and 1 year after operation.Results Before operation,HKA,WBL ratio and potential lateral laxity in high JLCA group were significantly lower than those in low JLCA group(P<0.05),and the Kellgren and Lawrence scores of high JLCA group were higher than those of low JLCA group(P<0.05).There was no significant difference in TPS,MPTA,total JLCA or JLO between two groups(P>0.05).Compared with low JLCA group,high JLCA group had higher supine JLCA,ΔJLCA,inversion and eversion JLCA and potential medial laxity(P<0.05),and smaller ROM(P<0.05).No significant difference was found in any clinical scores between two groups(all P>0.05).After operation,the differences between two groups in HKA,correction error,WBL ratio,TPS,MPTA bone correction,total JLCA or JLO were trivial(P>0.05).However,the correction angle and soft tissue correction of high JLCA group were larger than those of low JLCA group(P<0.05);and the postoperative JLCA,ΔJLCA,inverted and everted JLCA in high JLCA group were higher than those in low JLCA group(P<0.05);and the postoperative ROM of low JLCA group was larger than that of high JLCA group(P<0.05).There was no significant difference in any postoperative clinical scores between two groups(P>0.05).JLCA in the supine position before operation was correlated with JLCA in the standing position after operation(r=0.696,P<0.001).Conclusion When controlling intraoperative

关 键 词：开放楔形胫骨高位截骨术 关节线收敛角 膝关节活动度 膝关节评分 

分 类 号：R681.8[医药卫生—骨科学]