胫骨内侧开放楔形截骨术对膝内翻患者踝关节的影响  

Efficacy of Open-Weigh High Tibial Osteotomy of Lateral Tibia on Ankle Joint of Patients with Genu Varum

作　　者：吴子光 何君源[2] 唐剑邦[2] 彭键勇 黄治华 郑炜宏[2] WU Ziguang;HE Junyuan;TANG Jianbang;PENG Jianyong;HUANG Zhihua;ZHENG Weihong(Guangzhou University of Traditional Chinese Medicine,Guangzhou 510405,China;Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400,Guangdong China)

机构地区：[1]广州中医药大学研究生院,广州510405 [2]中山市中医院

出　　处：《中国中医骨伤科杂志》2021年第11期18-23,27,共7页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：广东省中山市社会公益科技研究项目(2019B1003)。

摘　　要：目的:探究胫骨内侧开放楔形截骨术(Open-Weigh High Tibital Osteotomy,OWHTO)对膝内翻患者踝关节倾斜角度、关节对位及生物力学状态的影响。方法:选取2018年6月至2020年9月行OWHTO治疗膝骨性关节炎的37名内翻膝患者(43膝)进行随访,平均随访时间(9.4±2.6)个月,对所有患者术前、术后末次随访的站立位双下肢全长DR片上的胫骨近端内侧角(Medial Proximal Tibial Angle,MPTA)、髋膝角(Hip-Knee Angle,HKA)、踝关节线会聚角(Ankle Joint Line Convergence Angle,AJLCA)、胫骨平台倾斜角(Tibial Plafond Inclination Angle,TPIA)和踝关节线方向角(Ankle Joint Line Orientation Angle,AJLOA)进行测量,术后按下肢力线矫正角度大小将患者分为A组(5°~10°,14膝)、B组(10°~15°,15膝)、C组(>15°,14膝)进行比较。结果:术后随着HKA的改变,MPTA、AJLCA、TPIA、AJLOA均产生代偿性变化;配对秩和检验显示,术后所有患者HKA、MPTA、AJLCA、TPIA、AJLOA相比术前明显增大,差异有统计学意义(P<0.05);术后不同矫正角度组HKA、MPTA、AJLCA比较,差异有统计学意义(P<0.05)。结论:随着OWHTO矫正膝内翻畸形的下肢力线,踝关节倾斜角度、关节面对位及生物力学状态均产生了代偿性改变,提示OWHTO术前应对同侧踝关节进行仔细检查,避免术后出现踝关节并发症。Objective:To investigate the effect of open-weigh high tibial osteotomy(OWHTO)on the force line,alignment and biomechanics of the ankle in patients with genu varum.Methods:A total of 37 patients(43 knees)with genu varum treated with OWHTO from June 2018 to September 2020 were selected for follow-up.The average follow-up time was(9.4±2.6)months.The medial proximal tibial angle(MPTA),hip-knee angle(HKA),ankle join line convergence angle(AJLCA),tibial plafond inclination angle(TPIA)and ankle joint line orientation angle(AJLOA)of all patients’standing full-length DR films of both lower limbs were followed up at the preoperative time and the postoperative last time.Patients were divided into group A(5°to 10°,14 knees),group B(10°to 15°,15 knees)and group C(>15°,14 knees)according to the correction angle of lower limb force line after operation.Results:With the change of HKA,the compensatory changes of MPTA,AJLCA,TPIA and AJLOA occurred.Paired rank sum test showed that postoperative HKA,MPTA,AJLCA,TPIA and AJLOA of all patients were significantly higher than those of preoperative time(P<0.05).There were significant differences in the postoperative HKA,MPTA and AJLCA among different angle groups(P<0.05).Conclusion:As OWHTO corrects the force line of lower limbs of knee varus deformity,the inclination angle,the joint face position and the biomechanics condition of the ankle are changed compensatively,which suggests that OWHTO should examine the ipsilateral ankle before operation to avoid postoperative ankle complications.

关 键 词：膝内翻畸形 胫骨内侧开放楔形截骨术 踝关节对位 踝关节力线 影像学改变 

分 类 号：R684.3[医药卫生—骨科学]