髋-膝-踝角矫正率在胫骨高位截骨术中的应用  

Application of Hip Knee Ankle Angle Correction Rate in High Tibial Osteotomy

作　　者：李瑶 梁文卫 李梦溪[2] 郑兴国 周皓 沈凯 程蒋琪 崔维顶[1] Li Yao;Liang Wenwei;Li Mengxi;Zheng Xingguo;Zhou Hao;Shen Kai;Cheng Jiangqi;Cui Weiding(The First Affiliated Hospital to Nanjing Medical University,Nanjing 210029,China;Nanjing University of Information Science and Technology,Nanjing 210044,China)

机构地区：[1]南京医科大学第一附属医院骨科,江苏南京210029 [2]南京信息工程大学,江苏南京210044

出　　处：《实用骨科杂志》2023年第10期950-953,共4页Journal of Practical Orthopaedics

摘　　要：目的分析和探讨胫骨高位截骨术(high tibial osteotomy,HTO)治疗膝骨关节炎(knee osteoarthritis,KOA)时最佳的髋-膝-踝角(hip knee ankle,HKA)矫正率,为临床治疗提供参考。方法对2016年9月至2021年12月在南京医科大学第一附属医院接受HTO治疗的89例KOA患者进行分析,其中男35例,女54例;年龄38~68岁,平均(55.10±6.54)岁。以术前、术后3个月、术后1年为时间点,采用牛津膝关节评分量表(Oxford knee score,OKS)进行评分,并测量患者术前、术后的HKA。定义HTO术中HKA的矫正量(术后HKA与术前HKA之差的绝对值,即手术所造成的HKA变化量)与术前HKA之比为HKA矫正率(简称矫正率)。通过预设若干假定的理想矫正率,并与各患者术后实际达到的矫正率进行对比分析,研究矫正率与手术效果(以术前OKS评分与术后评分之差衡量)的关系。结果患者术后实际的矫正率与各假定理想矫正率中,某些预设值的偏差(二者之差的绝对值)与手术效果存在负相关。体现为:术后3个月的理想矫正率(对应P值最小)约为1.1~1.2,术后1年约为矫正率1.2,即手术矫正量为术前膝关节HKA内翻角的1.2倍左右,使膝关节术后HKA达到轻度外翻为宜。结论以矫正率1.2作为HTO矫正率目标值,即HTO术中矫正量为患者术前HKA内翻值的1.2倍,可取得较好的手术效果,此结论可为HTO的术前规划提供参考。Objective To analyze and investigate the optimal hip knee ankle(HKA)angle correction rate in the treatment of knee osteoarthritis(KOA)by high tibial osteotomy(HTO)for clinical treatment.Methods A total of 89 patients with KOA treated with HTO who met the inclusion criteria were analyzed,including 35 males and 54 females.The patients age ranged from 38 to 68 years,with an average of(55.10±6.54)years.The Oxford knee score(OKS)was used to score the patients before surgery,3 months after surgery and 1 year after surgery,and the patients’preoperative and postoperative HKA angles were measured.The ratio of the correction of HKA angle in HTO(the absolute value of the difference between the postoperative HKA angle and the preoperative HKA angle,the amount of change in the HKA angle caused by the surgery)to the preoperative HKA angle was defined as the correction rate of the HKA angle(hereinafter referred to as the correction rate).The relationship between the correction rate and the surgical outcome(measured as the difference between the preoperative OKS score and the postoperative score)was investigated by presetting a number of hypothetical ideal correction rates and analyzing them in comparison with the actual postoperative correction rates achieved by each patient.Results The deviation of a patient’s actual postoperative correction rate from some preset values of the presumed hypothetical ideal correction rate(the absolute value of the difference between the two)was negatively correlated with surgical outcome.This was reflected in the fact that the ideal correction rate(corresponding to the smallest P value)was about 1.1 to 1.2 at 3 months postoperatively and 1.2 at 1 year postoperatively,which mean that a reasonable amount of surgical correction should be about 1.2 times the preoperative knee HKA varus angle to achieve a mildly valgus knee HKA angle after surgery.Conclusion Using 1.2 as the target value of HTO correction rate,which means the amount of intraoperative correction of HTO is 1.2 times of the patient

关 键 词：膝关节 骨关节炎 胫骨高位截骨术 

分 类 号：R687.31[医药卫生—骨科学]