胫骨结节远端单平面截骨对踝关节冠状面角度的影响  

Effects of distal tibial tuberosity-high tibial osteotomy on ankle angle on coronal plane

作　　者：尹岳桐 朱光宇 田向东 谭冶彤 马晟 薛志鹏 胡元一 李晓敏 Yin Yuetong;Zhu Guangyu;Tian Xiangdong;Tan Yetong;Ma Sheng;Xue Zhipeng;Hu Yuanyi;Li Xiaomin(Third School of Clinical Medicine,Beijing University of Chinese Medicine,Beijing 100029,China;Department of Minimally Invasive Arthrology,Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学第三临床医学院,北京市100029 [2]北京中医药大学第三附属医院微创关节科,北京市100029

出　　处：《中国组织工程研究》2024年第21期3349-3354,共6页Chinese Journal of Tissue Engineering Research

基　　金：北京中医药大学重点攻关项目(2020-JYB-ZDGG-142-5),项目负责人:田向东。

摘　　要：背景:胫骨结节远端单平面截骨作为一种内侧单间室膝骨关节炎的手术治疗方法,目前缺乏其对踝关节影响的研究。目的:观察胫骨结节远端单平面截骨对患者负重位下肢X射线片上踝关节冠状面角度的影响。方法:回顾分析2021年3月至2022年3月行胫骨结节远端单平面截骨的膝骨关节炎患者共40例(41膝),其中女31例,男9例;左膝20例,右膝21例;年龄49-75岁,平均(63.44±6.57)岁。收集术前及术后第2,48周的负重位下肢全长X射线片资料,测量髋-膝-踝关节角、距骨倾斜角、踝关节倾斜角、胫骨踝穴角、胫骨远端关节面角的术前术后变化。结果与结论:①髋-膝-踝关节角由术前的(-6.24±3.69)°改善为术后第2周的(2.59±3.49)°,至第48周为(2.15±3.49)°;踝关节倾斜角由术前的(-7.90±3.11)改变为术后第2周的(-2.51±2.59)°,至第48周为(-2.46±2.42)°,差异均有显著性意义(P<0.001);②距骨倾斜角、胫骨踝穴角及胫骨远端关节面角的术前、术后2次随访差异无显著性意义;③第2周与第48周各角度差异均无显著性意义;④提示胫骨结节远端单平面截骨在纠正膝内翻的同时,能够改善踝关节的角度异常,且在48周负重活动后该角度保持稳定。BACKGROUND:Distal tibial tuberosity-high tibial osteotomy is a surgical treatment for knee osteoarthritis,but there is still a lack of clinical studies on its effect on ankle joints.OBJECTIVE:To observe the effects of distal tibial tuberosity-high tibial osteotomy on ankle angle on coronal plane of the radiography of the full length of lower limb in weight loading.METHODS:Data of 40 patients(41 knees)with distal tibial tuberosity-high tibial osteotomy from March 2021 to March 2022 were retrospectively analyzed,including 31 females and 9 males,20 left knees and 21 right knees,aged 49-75 years,mean(63.44±6.57)years.The radiographic data of the full length of the lower limb in weight loading were collected before,week 2 and week 48 postoperatively.Hip-knee-ankle angle,talar tilt angle,tilt angle of the ankle,tibiocrural angle,and tibial articular surface angle were measured before and after surgery.RESULTS AND CONCLUSION:(1)Hip-knee-ankle angle improved from(-6.24±3.69)°before operation to(2.59±3.49)°week 2 postoperatively and(2.15±3.49)°week 48 postoperatively.The tilt angle of the ankle changed from(-7.90±3.11)°before operation to(-2.51±2.59)°week 2 postoperatively and(-2.46±2.42)°week 48 postoperatively,with statistically significant difference(P<0.001).(2)There was no significant difference in talar tilt angle,tibiocrural angle,and tibial articular surface angle before and week 2 postoperatively.(3)No significant difference in the angle changes was detected between week 2 and week 48 postoperatively.(4)It is indicated that distal tibial tuberosity-high tibial osteotomy can not only correct genu varus but also improve ankle angle.This result remains stable after 48 weeks of weight-bearing activities.

关 键 词：膝骨关节炎 胫骨结节远端单平面截骨 踝关节 冠状面 影像学 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.4