基于下肢全长X线片及CT平扫探讨鹅足肌腱对胫骨高位截骨术后胫骨远端轴位旋转的影响  

Effect of pes anserinus tendon on distal tibial rotation in medial open-wedge high tibial osteotomy(MOWHTO)based on full weight-bearing long-leg anteroposterior X-rays and CT scan

作　　者：荆立忠[1] 杨久山[1] JING Lizhong;YANG Jiushan(Department of Orthopedics,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]山东中医药大学附属医院运动损伤骨科,山东济南250014

出　　处：《中国中西医结合影像学杂志》2024年第5期594-598,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:基于下肢全长X线片及CT平扫探讨内侧开放楔形胫骨高位截骨术(MOWHTO)后鹅足肌腱的有无对胫骨远端相对于胫骨近端轴位旋转的影响。方法:回顾性收集行MOWHTO的患者63例,根据术中对鹅足肌腱的处理情况,分为未松解组(对照组)、部分松解组(观察组1)和完全松解组(观察组2)各21例(21膝);同时收集自体腘绳肌腱行前交叉韧带重建的患者(观察组3)21例(21膝)。患者术前及术后1周内均行下肢全长正侧位X线检查及髋膝踝CT平扫,测量解剖股骨胫骨角(aFTA)、胫骨近端内侧角(MPTA)和胫骨扭转角(TTA),并进行比较。结果:观察组1、观察组2、观察组3及对照组aFTA分别由术前(180.85±2.51)°、(180.30±2.18)°、(181.01±2.06)°和(181.34±1.98)°,矫正为术后(173.85±1.83)°、(174.11±1.34)°、(173.33±1.56)°和(174.26±1.77)°;MPTA由术前(80.23±1.83)°、(79.37±1.62)°、(81.01±1.52)°和(80.90±1.37)°,矫正为术后(89.54±2.33)°、(88.26±1.89)°、(87.58±1.01)°和(88.42±1.25)°。4组间术前aFTA、术后aFTA、术前MPTA、术后MPTA的差异均无统计学意义(均P>0.05);4组术后与术前TTA差值分别为(-0.52±0.99)°、(-0.07±2.06)°、(-0.13±1.37)°和(-0.89±1.21)°,观察组2、观察组3与对照组相比,差异均有统计学意义(均P<0.05)。结论:完整的鹅足肌腱可导致MOWHTO后胫骨远端相对于胫骨近端内旋,对其进行松解会削弱此作用,在MOWHTO中需合理处理鹅足肌腱,以尽量避免非计划的胫骨扭转。Objective:To evaluate the effect of pes anserinus tendon on distal tibial rotation in medial open-wedge high tibial osteotomy(MOWHTO)based on full weight-bearing long-leg anteroposterior X-rays and CT scan.Methods:A total of 63 patients who underwent MOWHTO were selected.According to the intraoperative handling of the pes anserinus tendon,63 cases were divided into the non-release group(control group),the partial release group(observation group 1)and the complete release group(observation group 2),21 cases with 21 knees in each group.And 21 patients(21 knees)who underwent anterior cruciate ligament reconstruction(ACLR)using autogenous hamstring tendon were also included in the study(observation group 3).Full weight-bearing long-leg anteroposterior X-rays and CT scan were performed before and within 1 week after the operation,and aFTA,MPTA,TTA were measured and compared.Results:The preoperative aFTA values for the observation group 1,observation group 2,observation group 3 and the control group were(180.85±2.51)°,(180.30±2.18)°,(181.01±2.06)°and(181.34±1.98)°,and the postoperative aFTA were(173.85±1.83)°,(174.11±1.34)°,(173.33±1.56)°and(174.26±1.77)°,respectively.MPTA changed from(80.23±1.83)°,(79.37±1.62)°,(81.01±1.52)°,(80.90±1.37)°preoperatively to(89.54±2.33)°,(88.26±1.89)°,(87.58±1.01)°,and(88.42±1.25)°postoperatively.There were no significant differences between preoperative aFTA and postoperative aFTA or between preoperative MPTA and postoperative MPTA among the four groups(all P>0.05).The TTA difference before and after operation in 4 groups was(-0.52±0.99)°,(-0.07±2.06)°,(-0.13±1.37)°,(-0.89±1.21)°,and the differences between the observation group 2,observation group 3 and the control group were statistically significant(both P<0.05).Conclusions:The intact pes anserinus tendon could cause internal rotation of the distal tibia after MOWHTO and releasing it could weaken this effect.In MOWHTO,it is important to handle the pes anserinus tendon properly to minimize unpla

关 键 词：胫骨高位截骨术 鹅足肌腱 前交叉韧带重建 胫骨扭转 体层摄影术 X线计算机 放射摄影术 

分 类 号：R687.3[医药卫生—骨科学] R816.8[医药卫生—外科学]