模拟负重CT定位像下肢全长片在膝骨关节炎胫骨高位截骨术中的应用  

Application of Simulated Weight-Bearing CT Topogram Full-Length Imaging of Lower Limbs in High Tibial Osteotomy of Knee Osteoarthritis

作　　者：郭浩山 谢晓音 刘晓之 周占国 安龙 关涛 杨久山[3] GUO Haoshan;XIE Xiaoyin;LIU Xiaozhi;ZHOU Zhanguo;AN Long;GUAN Tao;YANG Jiushan(Department of Orthopaedics,Liaocheng Hospital of Traditional Chinese Medicine,Liaocheng 252000,Shandong China;Medical Imaging Center,Liaocheng Veterans Hospital,Liaocheng 252000,Shandong China;Department of Orthopedics for Sports Injuries,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]聊城市中医医院骨科,山东聊城252000 [2]聊城市退役军人医院医学影像中心 [3]山东中医药大学附属医院运动损伤骨科

出　　处：《中国中医骨伤科杂志》2023年第8期54-58,63,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：山东省中医药科技项目(2021Q011);聊城市重点研发计划政策引导类项目(2022YDSF66)。

摘　　要：目的:探讨模拟负重CT定位像下肢全长片在膝骨关节炎胫骨高位截骨术中的应用价值。方法:自2017年5月至2022年1月对32例内侧间室膝骨关节炎患者实施开放楔形胫骨高位截骨术(OWHTO)。男18例,女14例;年龄为40~67岁,平均为56.6岁;病程为8~36个月,平均为(15.31±4.43)个月。膝关节骨关节炎Kellgren-Lawrence(K-L)分级Ⅱ级9例,Ⅲ级23例。美国特种外科医院(HSS)膝关节功能评分为(71.16±7.92)分,视觉模拟量表(VAS)评分为(5.65±1.75)分,术前利用模拟负重CT定位像获取双下肢全长片,测量胫骨近端内侧角(MPTA)为82.32°±1.44°,股胫角(FTA)为185.62°±5.97°。运用Miniaci法进行术前设计,预估术中畸形矫正角度α,根据Hernigou's三角函数表估算截骨端撑开距离h。术中通过C臂机透视监测下肢力线矫正至目标位置,对实际撑开距离h'进行记录,术后复查模拟负重CT定位像下肢全长片,测量术后胫骨近端内侧角及股胫角,并在随访时记录VAS评分及HSS膝关节功能评分,对疗效进行评价。结果:所有病例均获随访,随访时间为6~60个月,平均为26个月;术前预估截骨端撑开距离h为(10.85±2.17)mm,实际撑开距离h'为(11.31±2.59)mm,经配对样本t检验,两者差异无统计学意义(t=1.828,P=0.116)。术后2周内复查胫骨近端内侧角为89.57°±1.31°,股胫角为172.98°±2.63°,经配对样本t检验,两者与术前差异均有统计学意义(P<0.05)。末次随访VAS评分为(1.81±0.65)分,HSS评分为(90.20±7.37)分,经配对样本t检验,两者与术前差异均有统计学意义(P<0.05)。结论:利用模拟负重CT定位像下肢全长片开展的开放楔形胫骨高位截骨术,能够获得满意的临床疗效,疼痛和膝关节功能均得到明显改善。通过模拟负重CT定位像获得的下肢全长片,可以在开放楔形胫骨高位截骨术术前、术后对下肢力线进行较好的评价,并通过Miniaci法对畸形矫正程度进行较为准确的预测,降低下肢全�Objective:To investigate the application value of simulated weight-bearing CT topogram full-length imaging of lower limbs in high tibial osteotomy(HTO)for knee osteoarthritis(KOA).Methods:A total of 32 patients with medial compartment KOA underwent open wedge high tibial osteotomy(OWHTO)from May 2017 to January 2022.The patients'demographics and preoperative parameters,including Kellgren-Lawrence grade,hospital for special surgery(HSS)knee function score,visual analogue scale(VAS)score,medial proximal tibial angle(MPTA),and femoral-tibial angle(FTA),were recorded.Preoperative design was performed using the Miniaci method,and intraoperative deformity correction angle(α)and distraction distance(h)were estimated.C-arm fluoroscopy was used during the operation for alignment monitoring.Simulated weight-bearing CT topogram full-length imaging of lower limbs was conducted postoperatively to measure MPTA and FTA.VAS score and HSS knee function score were assessed during follow-up to evaluate efficacy.Results:All patients were followed up for an average of 26 months(range:6-60 months).The estimated and actual distraction distances(h')showed no significant difference(P=0.116).Postoperative MPTA(89.57°±1.31°)and FTA(172.98°±2.63°)were significantly different compared to preoperative values(P<0.05).At the last follow-up,the VAS score was(1.81±0.65)points and the HSS knee function score was(90.20±7.37)points,both showing significant improvement compared to preoperative scores(P<0.05).Conclusion:Open wedge high tibial osteotomy(OWHTO)with simulated weight-bearing CT topogram full-length imaging of lower limbs demonstrates satisfactory clinical efficacy,resulting in significant pain relief and improvement in knee joint function.This imaging technique enables accurate evaluation of lower limb alignment before and after high tibial osteotomy(HTO)and enhances the prediction of deformity correction.It reduces the requirements for imaging equipment and splicing technology,making it suitable for implementation in primary hos

关 键 词：胫骨高位截骨术 下肢全长片 CT定位像 

分 类 号：R684.3[医药卫生—骨科学]