内侧开放楔形胫骨高位截骨后遗忘关节的预测因素  

Predictors of a forgotten joint after medial open wedge high tibial osteotomy

作　　者：黄艺伟 彭波 张辰 葛昊 黎嘉澔 李宜金 陈锦伦 冯文俊[2] 曾意荣[2] Huang Yiwei;Peng Bo;Zhang Chen;Ge Hao;Li Jiahao;Li Yijin;Chen Jinlun;Feng Wenjun;Zeng Yirong(First Clinical Medical School,Guangzhou University of Chinese Medicine,Guangzhou 510000,Guangdong Province,China;Department of Joint Surgery,First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510000,Guangdong Province,China)

机构地区：[1]广州中医药大学第一临床医学院,广东省广州市510000 [2]广州中医药大学第一附属医院关节骨科,广东省广州市510000

出　　处：《中国组织工程研究》2024年第24期3903-3909,共7页Chinese Journal of Tissue Engineering Research

基　　金：广州中医药大学第一附属医院高水平医院建设项目(211010010722),项目负责人:曾意荣;广州市科技计划项目(202201020585),项目负责人:曾意荣;国家自然科学基金青年科学项目(82104882),项目负责人:冯文俊。

摘　　要：背景:内侧开放楔形胫骨高位截骨是治疗膝关节内侧间室骨关节炎的有效保膝手段,相关研究证明相对于传统评价工具,遗忘关节评分应用于评价内侧开放楔形胫骨高位截骨具有更低的天花板效应和一致性。目的:探讨内侧开放楔形胫骨高位截骨后遗忘关节的预测因素。方法:选择在广州中医药大学第一附属医院进行内侧开放楔形胫骨高位截骨手术治疗的患者117例,男35例,女82例,平均年龄61岁,术后获得了至少2年的随访。通过评价患者术后是否达到遗忘关节分为遗忘关节组(n=28)和非遗忘关节组(n=89),以术前患者特征和手术相关因素为潜在预测因素,进行单变量和多变量逻辑回归分析。结果与结论:①两组患者术前的胫骨近端内侧角比较差异有显著性意义(P<0.05),术后遗忘关节评分(FJS)、膝关节损伤和骨关节炎评分(KOOS)、膝关节协会功能评分和关节感知问题(PJP)比较差异均有显著性意义(P<0.05),术后髋膝踝角和胫骨近端内侧角比较差异有显著性意义(P<0.05);②单因素Logistic回归分析显示,术前胫骨近端内侧角对遗忘关节存在显著影响[OR=0.755,95%CI(0.635-0.897),P<0.001],术后髋膝踝角和术后胫骨近端内侧角对遗忘关节存在显著影响[OR=1.546,95%CI(1.242-1.924),P<0.001;OR=0.815,95%CI(0.713-0.931),P=0.003];③多因素Logistic回归分析显示,术前膝骨关节炎K-L分级为1级是获得遗忘关节的有利因素,术前胫骨近端内侧角和术后髋膝踝角是遗忘关节的独立预测因素,两者与实现遗忘关节概率呈曲线关系;当术前胫骨近端内侧角每增加1°,实现遗忘关节的概率就会减少27.7%[OR=0.723,95%CI(0.593-0.882),P<0.001];当术后髋膝踝角每增加1°,实现遗忘关节的概率就会增加46.4%[OR=1.464,95%CI(1.153-1.860),P=0.002];④结果显示,术前膝骨关节炎K-L分级为1级、胫骨近端内侧角较小(<85.5°)和术后髋膝踝角较大(>176.0°)是患者实现遗忘关BACKGROUND:Medial open wedge high tibial osteotomy is an effective procedure for preserving the knee joint in patients with medial compartmental osteoarthritis.Previous studies have demonstrated that the forgotten joint score provides a lower ceiling effect and consistency of medial open wedge high tibial osteotomy outcomes compared to traditional assessment tools.OBJECTIVE:To identify predictive factors associated with the occurrence of a forgotten joint after medial open wedge high tibial osteotomy.METHODS:117 patients with medial open wedge high tibial osteotomy who were treated at First Affiliated Hospital of Guangzhou University of Chinese Medicine were selected,including 35 males and 82 females,with an average age of 61 years.They were followed up for at least 2 years.Patients were divided into a forgotten joint group(n=28)and a non-forgotten joint group(n=89)by evaluating whether they achieved forgotten joint after surgery.Univariate and multivariate logistic regression analyses were performed with preoperative patient characteristics and surgery-related factors as potential predictors.RESULTS AND CONCLUSION:(1)There were significant differences in the proximal medial tibial angle between the two groups before surgery(P<0.05).There were significant differences in the forgotten joint score,Knee Injury and Osteoarthritis Outcome Score,knee society knee score,function score,and patients joint perception between the two groups after surgery(P<0.05).There was a significant difference between the hip-knee-ankle angle and the medial proximal tibial angle after operation(P<0.05).(2)Univariate Logistic regression analysis showed that the medial proximal tibial angle had a significant influence on the forgotten joint before operation[OR=0.755,95%CI(0.635-0.897),P<0.001].There were significant effects on the forgotten joint of hip-knee-ankle angle and medial proximal tibial angle[OR=1.546,95%CI(1.242-1.924),P<0.001;OR=0.815,95%CI(0.713-0.931),P=0.003].(3)Multivariate logistic regression analysis showed that preoperat

关 键 词：内侧开放楔形胫骨高位截骨 遗忘关节评分 膝关节内侧间室骨关节炎 预测因素 遗忘关节 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R684.3