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Title: [Effectiveness of intraoperative tibia fibular angle and femoral fibular angle in predicting coronal lower limb alignment after medial open-wedge high tibial osteotomy].
Author: Mao Y, He A, Zhou Y, Chen Y, Liu Y, Yu X, Zhang X, Liu W.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2022 Jan 15; 36(1):58-64. PubMed ID: 35038800.
Abstract:
OBJECTIVE: To explore the prediction of postoperative coronal lower limb alignment by the tibia fibular angle (TFA) and femoral fibular angle (FFA) after osteotomy in medial open-wedge high tibial osteotomy (MOWHTO). METHODS: A clinical data of 20 patients with medial compartment osteoarthritis, who were treated with MOWHTO between September 2019 and September 2020, was retrospectively analyzed. Among them, there were 9 males and 11 females; the age ranged from 46 to 69 years, with an average of 56.0 years. The body mass index (BMI) was 21.3- 35.7 kg/m ², with an average of 26.7 kg/m ². Osteoarthritis involved 11 cases of left knee and 9 cases of right knee; the disease duration was 2-6 years, with an average of 3.8 years. According to the Kellgren-Lawrence classification, there were 7 cases of grade Ⅰ, 9 cases of grade Ⅱ, and 4 cases of grade Ⅲ. The angle and height for open-wedge was planned preoperatively by osteotomy master software, and the TFA and FFA were measured by software after simulated osteotomy. The intraoperative angle for open-wedge was adjusted according to TFA and FFA after simulated osteotomy.The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical femorotibial angle (mFTA), weight-bearing line (WBL) ratio, TFA, and FFA were measured before operation and at 2 days after operation. The difference (X) between the intraoperative measurement value and the preoperative plan value of TFA/FFA, and the difference (Y) between the postoperative WBL ratio and the target alignment (62.5%) were calculated, and the correlation between the two indicators was analyzed by Pearson's test. According to the median BMI of patients (25.81 kg/m ²), the patients were allocated into high BMI group (>25.81 kg/m ², n=10) and low BMI group (≤25.81 kg/m ², n=10), and the influencing factors of WBL ratio was analyzed by linear regression. RESULTS: There was no significant difference between pre- and post-operation in LDFA and JLCA ( P>0.05); while there were significant differences between pre- and post-operation in MPTA, mFTA, and WBL ratio ( P<0.05). The TFA was (89.5±4.0)° during operation and (87.7±4.7)° after operation, showing significant difference ( t=2.991, P=0.008). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of TFA and the difference (Y) between the postoperative WBL ratio and the target alignment ( r=0.595, P=0.006). The FFA was (86.9±4.3)° during operation and (85.7±4.4)° after operation, showing significant difference ( t=1.760， P=0.094). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of FFA and the difference (Y) between the postoperative WBL ratio and the target alignment ( r=0.536, P=0.015). After BMI stratification, X was an influential factor of Y in the low BMI group ( P<0.05), but X was not an influential factor of Y in the high BMI group ( P>0.05). CONCLUSION: Intraoperative FFA and TFA can predict coronal limb alignment after MOWHTO. FFA and TFA can predict more preciselyfor patients with BMI≤25.81 kg/m ². 目的: 探讨以胫骨内侧开放高位截骨术（medial open-wedge high tibial osteotomy，MOWHTO）中截骨后的胫骨腓骨角（tibia fibular angle，TFA）、股骨腓骨角（femoral fibular angle，FFA）预测术后下肢冠状位力线的有效性。. 方法: 回顾分析2019年9月—2020年9月20例采用MOWHTO治疗的膝关节内侧间室骨关节炎患者临床资料。其中男9例，女11例；年龄46～69岁，平均56.0岁。身体质量指数（body mass index，BMI）21.3～35.7 kg/m ²，平均26.7 kg/m ²。骨关节炎累及左膝11例、右膝9例；病程2～6年，平均3.8年；Kellgren-Lawrence分级：Ⅰ级7例，Ⅱ级9例，Ⅲ级4例。术前使用截骨大师软件设计截骨撑开高度和角度，测量模拟截骨撑开后的TFA、FFA；术中参考术前模拟撑开后TFA、FFA调整实际撑开高度。测量并比较术前及术后第2天股骨远端外侧角（lateral distal femoral angle，LDFA）、胫骨近端内侧角（medial proximal tibial angle，MPTA）、关节线汇聚角（joint line convergence angle，JLCA）、股骨胫骨机械轴夹角（mechanical femorotibial angle，mFTA）、关节承重线（weight-bearing line，WBL）比率、TFA、FFA。计算TFA、FFA术中测量值与术前计划值差值（X），术后WBL比率与目标力线（62.5%）差值（Y），采用Pearson检验分析两指标相关性。根据患者BMI中位数（25.81 kg/m ²），将患者分为高BMI组（>25.81 kg/m ²， n=10）以及低BMI组（≤25.81 kg/m ²， n=10），通过直线回归分析WBL比率的影响因素。. 结果: 手术前后LDFA、JLCA比较，差异无统计学意义（ P>0.05）；MPTA、mFTA、WBL比率比较，差异有统计学意义（ P<0.05）。TFA术中测量值为（89.5±4.0）°，术后为（87.7±4.7）°，差异有统计学意义（ t=2.991， P=0.008）；TFA术中测量值与术前计划值差值（X）与术后WBL比率与目标力线差值（Y）成正相关（ r=0.595， P=0.006）。FFA术中测量为（86.9±4.3）°，术后为（85.7±4.4）°，差异无统计学意义（ t=1.760， P=0.094）；FFA术中测量值与术前计划值差值（X）与术后WBL比率与目标力线差值（Y）成正相关（ r=0.536， P=0.015）。经过BMI分层，在低BMI组X是Y的影响因素（ P<0.05），但在高BMI组中X不是Y的影响因素（ P>0.05）。. 结论: 术中截骨撑开后的FFA和TFA可以预测术后下肢冠状位力线，对于BMI≤25.81 kg/m ²的患者预测更准确。.

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