对齐杆和间隙测量法在针对骨关节炎膝关节外翻的开放式楔形高胫骨截骨术中实现了可比的对齐校正

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-10-16 DOI:10.1002/jeo2.70038

Shintaro Onishi, Youngji Kim, Hiroshi Nakayama, Christophe Jacquet, Ahmed Mabrouk, Matthieu Ollivier

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引用次数: 0

摘要

目的比较使用两种不同对位方法：对位杆法（AR）和间隙测量法（GM）进行内侧开口楔形高胫骨截骨术（MOWHTO）的临床和放射学结果。主要结果是报告每种方法的冠状面校正手术准确性。方法纳入2014年至2022年期间在一家机构接受AR或GM方法MOWHTO手术的患者，随访至少2年。AR组患者在透视控制下使用AR逐渐扩大截骨间隙，而GM组患者除骨锯厚度外，截骨部位还扩大到测量的间隙距离值。几何特征的放射学评估包括髋膝踝角（HKA）、胫骨内侧近端角（MPTA）、机械股骨外侧远端角和关节线会聚角。比较了两种方法的手术准确性，即预期矫正与实际矫正之间的偏差 (Δ)。临床结果采用膝关节损伤和骨关节炎结果评分进行评估。结果总共有 110 名患者（n = 110 膝关节）参与了研究，平均年龄为 54.1 ± 8.4 岁。2年后，放射学参数明显改善，AR组的HKA校正从171.6°±2.0°提高到181.1°±2.6°，GM组的HKA校正从171.0°±2.3°提高到181.1°±2.8°（组间差异不显著）。所有放射学参数和临床结果均无明显组间差异。根据 HKA 和 MPTA 的Δ值和绝对Δ值评估，手术准确性没有组间差异（n.s）。结论在 MOWHTO 中使用 AR 或 GM 方法均可获得相当的校正精度。GM方法简单可靠，能在MOWHTO中达到预期的校正效果。证据等级 Ⅲ回顾性比较研究。

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Alignment rod and gap measurement methods achieve comparable alignment correction in opening wedge high tibial osteotomy for varus osteoarthritic knees

Purpose

To compare clinical and radiological outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using two different alignment methods: the alignment rod (AR) versus the gap measurement (GM) method. The primary outcome was to report the surgical accuracy of coronal plane corrections in each method.

Methods

Patients who underwent MOWHTO with either AR or GM method between 2014 and 2022 at a single institution, with a minimum of 2 years of follow-up, were included. The opening gap was gradually spread with an AR under fluoroscopic control in the AR group, whereas the osteotomy site was opened to the value of the measured gap distance in addition to the thickness of the bone saw in the GM group. Radiological assessment of geometric characteristics included hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle and joint line convergence angle. Surgical accuracy, which is the deviation (Δ) between the intended and achieved correction, was compared between both methods. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Scores.

Results

A total of 110 patients (n = 110 knees) with a mean age of 54.1 ± 8.4 years were included in the study. Radiological parameters were significantly improved as reflected by HKA correction from 171.6° ± 2.0° to 181.1° ± 2.6° in the AR group and from 171.0° ± 2.3° to 181.1° ± 2.8° in the GM group at 2 years (Intergroup n.s). There was no significant intergroup difference for all radiological parameters and clinical outcomes. There was no intergroup difference in the surgical accuracy as evaluated by Δvalues and absolute Δvalues of both HKA and MPTA (n.s).

Conclusions

Comparable correction accuracy was achieved in MOWHTO using either the AR or GM method. The GM method is simple and reliable in achieving the intended correction in MOWHTO.