{"title":"股骨远端外翻内侧闭合楔形截骨术后股胫关节的应力分布模式:使用计算机断层扫描骨吸收测量法进行评估","authors":"Masanari Hamasaki, Eiji Kondo, Koji Iwasaki, Yuki Suzuki, Masatake Matsuoka, Tomohiro Onodera, Koji Yabuuchi, Daisuke Momma, Masayuki Inoue, Kazunori Yasuda, Tomonori Yagi, Norimasa Iwasaki","doi":"10.1177/03635465241285909","DOIUrl":null,"url":null,"abstract":"Background:Distal femoral varus osteotomy (DFVO) is an established surgical procedure for addressing valgus malalignment across various knee conditions. However, the effect of DFVO on stress distribution within the femorotibial joint has not been explored through in vivo studies.Purpose:To (1) explore the distribution pattern of subchondral bone density across the proximal tibia in nonarthritic knees without arthritis and in those of patients with valgus knees, (2) assess changes in the pattern of bone density distribution in patients with valgus knees before and after medial closing-wedge (MCW) DFVO, and (3) determine the correlation between leg alignment and changes in bone density distribution.Study Design:Cohort study; Level of evidence, 3.Methods:The authors retrospectively analyzed clinical and radiographic data from 14 patients (14 knees; mean age, 44 years; 3 men, 11 women) treated with MCW-DFVO for lateral compartment osteoarthritis (OA) due to valgus malalignment, alongside a control group of 18 patients (18 knees; mean age, 21 years; 4 men, 14 women) without OA. The distribution patterns of subchondral bone density distribution on the femorotibial articular surface of the tibia were examined both preoperatively and >1 year postoperatively using computed tomography osteoabsorptiometry. Quantitative analyses were conducted on the locations and percentages of the high-density areas (HDAs) on the articular surface. The mean time between surgery and the postoperative radiograph and computed tomography absorptiometry imaging was 13.6 months (range, 11-19 months). The mean length of clinical follow-up was 28.7 months (range, 14-62 months) after surgery.Results:The mean proportion of HDA in the lateral compartment relative to the total HDA (lateral ratio) was significantly greater in the preoperative OA group (58.8%) compared with the control group (41.1%) ( P < .001). After MCW-DFVO, the mean lateral ratio in the OA group notably declined to 45.3% ( P < .001). The lateral ratio exhibited a significant correlation with the hip-knee-ankle angle in both the control ( r = 0.630; P = .011) and OA ( r = 0.537; P = .047) groups. Moreover, the alteration in the lateral ratio after MCW-DFVO showed a significant relationship with changes in the hip-knee-ankle angle ( r = 0.742; P = .002) and the mechanical lateral distal femoral angle ( r = −0.752; P = .002). Within the lateral compartment, HDAs in the 3 lateral regions of the 4 lateral subregions diminished after MCW-DFVO, whereas in the medial compartment, HDAs in the 3 lateral subregions saw an increase.Conclusion:The mean lateral ratio was significantly greater in the preoperative OA group compared with the control group. MCW-DFVO resulted in a redistribution of HDA from the lateral to the medial compartment of the proximal tibial articular surface. The extent of alignment correction after MCW-DFVO was closely linked to the shifts in HDA distribution, reflecting changes in stress distribution.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stress Distribution Patterns of the Femorotibial Joint After Medial Closing-Wedge Distal Femoral Varus Osteotomy: An Evaluation Using Computed Tomography Osteoabsorptiometry\",\"authors\":\"Masanari Hamasaki, Eiji Kondo, Koji Iwasaki, Yuki Suzuki, Masatake Matsuoka, Tomohiro Onodera, Koji Yabuuchi, Daisuke Momma, Masayuki Inoue, Kazunori Yasuda, Tomonori Yagi, Norimasa Iwasaki\",\"doi\":\"10.1177/03635465241285909\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background:Distal femoral varus osteotomy (DFVO) is an established surgical procedure for addressing valgus malalignment across various knee conditions. However, the effect of DFVO on stress distribution within the femorotibial joint has not been explored through in vivo studies.Purpose:To (1) explore the distribution pattern of subchondral bone density across the proximal tibia in nonarthritic knees without arthritis and in those of patients with valgus knees, (2) assess changes in the pattern of bone density distribution in patients with valgus knees before and after medial closing-wedge (MCW) DFVO, and (3) determine the correlation between leg alignment and changes in bone density distribution.Study Design:Cohort study; Level of evidence, 3.Methods:The authors retrospectively analyzed clinical and radiographic data from 14 patients (14 knees; mean age, 44 years; 3 men, 11 women) treated with MCW-DFVO for lateral compartment osteoarthritis (OA) due to valgus malalignment, alongside a control group of 18 patients (18 knees; mean age, 21 years; 4 men, 14 women) without OA. The distribution patterns of subchondral bone density distribution on the femorotibial articular surface of the tibia were examined both preoperatively and >1 year postoperatively using computed tomography osteoabsorptiometry. Quantitative analyses were conducted on the locations and percentages of the high-density areas (HDAs) on the articular surface. The mean time between surgery and the postoperative radiograph and computed tomography absorptiometry imaging was 13.6 months (range, 11-19 months). The mean length of clinical follow-up was 28.7 months (range, 14-62 months) after surgery.Results:The mean proportion of HDA in the lateral compartment relative to the total HDA (lateral ratio) was significantly greater in the preoperative OA group (58.8%) compared with the control group (41.1%) ( P < .001). After MCW-DFVO, the mean lateral ratio in the OA group notably declined to 45.3% ( P < .001). The lateral ratio exhibited a significant correlation with the hip-knee-ankle angle in both the control ( r = 0.630; P = .011) and OA ( r = 0.537; P = .047) groups. Moreover, the alteration in the lateral ratio after MCW-DFVO showed a significant relationship with changes in the hip-knee-ankle angle ( r = 0.742; P = .002) and the mechanical lateral distal femoral angle ( r = −0.752; P = .002). Within the lateral compartment, HDAs in the 3 lateral regions of the 4 lateral subregions diminished after MCW-DFVO, whereas in the medial compartment, HDAs in the 3 lateral subregions saw an increase.Conclusion:The mean lateral ratio was significantly greater in the preoperative OA group compared with the control group. MCW-DFVO resulted in a redistribution of HDA from the lateral to the medial compartment of the proximal tibial articular surface. The extent of alignment correction after MCW-DFVO was closely linked to the shifts in HDA distribution, reflecting changes in stress distribution.\",\"PeriodicalId\":517411,\"journal\":{\"name\":\"The American Journal of Sports Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-10-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The American Journal of Sports Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/03635465241285909\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The American Journal of Sports Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/03635465241285909","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:股骨远端外翻截骨术(DFVO)是治疗各种膝关节外翻错位的成熟手术方法。然而,股骨远端外翻截骨术对股胫关节内应力分布的影响尚未通过活体研究进行探讨。目的:(1)探讨无关节炎的非关节炎膝关节和膝内翻患者胫骨近端软骨下骨密度的分布模式;(2)评估膝内翻患者在内侧闭合楔(MCW)DFVO前后骨密度分布模式的变化;(3)确定腿部排列与骨密度分布变化之间的相关性。研究设计:队列研究;证据级别:3。方法:作者回顾性分析了14名患者(14个膝关节;平均年龄44岁;3名男性,11名女性)的临床和影像学数据,这些患者因膝关节外翻导致外侧厢骨性关节炎(OA)而接受了MCW-DFVO治疗,同时还分析了18名无OA的对照组患者(18个膝关节;平均年龄21岁;4名男性,14名女性)的临床和影像学数据。采用计算机断层扫描骨吸收测量法对术前和术后一年胫骨股胫关节面软骨下骨密度分布模式进行了检查。对关节表面高密度区(HDA)的位置和百分比进行了定量分析。从手术到术后拍片和进行计算机断层扫描骨吸收测定成像的平均时间为13.6个月(11-19个月)。结果:与对照组(41.1%)相比,术前OA组(58.8%)外侧区HDA占总HDA的平均比例(外侧比)明显更高(P <.001)。MCW-DFVO 术后,OA 组的平均侧向比值明显下降至 45.3% ( P <.001)。对照组(r = 0.630; P = .011)和 OA 组(r = 0.537; P = .047)的外侧比率与髋关节-膝关节-踝关节角度呈显著相关。此外,MCW-DFVO 后外侧比率的改变与髋-膝-踝角度(r = 0.742;P = .002)和机械外侧股骨远端角度(r = -0.752;P = .002)的变化有显著关系。结论:与对照组相比,术前OA组的平均外侧比率显著增大。MCW-DFVO导致胫骨近端关节面的HDA从外侧向内侧重新分布。MCW-DFVO术后的对位矫正程度与HDA分布的变化密切相关,反映了应力分布的变化。
Stress Distribution Patterns of the Femorotibial Joint After Medial Closing-Wedge Distal Femoral Varus Osteotomy: An Evaluation Using Computed Tomography Osteoabsorptiometry
Background:Distal femoral varus osteotomy (DFVO) is an established surgical procedure for addressing valgus malalignment across various knee conditions. However, the effect of DFVO on stress distribution within the femorotibial joint has not been explored through in vivo studies.Purpose:To (1) explore the distribution pattern of subchondral bone density across the proximal tibia in nonarthritic knees without arthritis and in those of patients with valgus knees, (2) assess changes in the pattern of bone density distribution in patients with valgus knees before and after medial closing-wedge (MCW) DFVO, and (3) determine the correlation between leg alignment and changes in bone density distribution.Study Design:Cohort study; Level of evidence, 3.Methods:The authors retrospectively analyzed clinical and radiographic data from 14 patients (14 knees; mean age, 44 years; 3 men, 11 women) treated with MCW-DFVO for lateral compartment osteoarthritis (OA) due to valgus malalignment, alongside a control group of 18 patients (18 knees; mean age, 21 years; 4 men, 14 women) without OA. The distribution patterns of subchondral bone density distribution on the femorotibial articular surface of the tibia were examined both preoperatively and >1 year postoperatively using computed tomography osteoabsorptiometry. Quantitative analyses were conducted on the locations and percentages of the high-density areas (HDAs) on the articular surface. The mean time between surgery and the postoperative radiograph and computed tomography absorptiometry imaging was 13.6 months (range, 11-19 months). The mean length of clinical follow-up was 28.7 months (range, 14-62 months) after surgery.Results:The mean proportion of HDA in the lateral compartment relative to the total HDA (lateral ratio) was significantly greater in the preoperative OA group (58.8%) compared with the control group (41.1%) ( P < .001). After MCW-DFVO, the mean lateral ratio in the OA group notably declined to 45.3% ( P < .001). The lateral ratio exhibited a significant correlation with the hip-knee-ankle angle in both the control ( r = 0.630; P = .011) and OA ( r = 0.537; P = .047) groups. Moreover, the alteration in the lateral ratio after MCW-DFVO showed a significant relationship with changes in the hip-knee-ankle angle ( r = 0.742; P = .002) and the mechanical lateral distal femoral angle ( r = −0.752; P = .002). Within the lateral compartment, HDAs in the 3 lateral regions of the 4 lateral subregions diminished after MCW-DFVO, whereas in the medial compartment, HDAs in the 3 lateral subregions saw an increase.Conclusion:The mean lateral ratio was significantly greater in the preoperative OA group compared with the control group. MCW-DFVO resulted in a redistribution of HDA from the lateral to the medial compartment of the proximal tibial articular surface. The extent of alignment correction after MCW-DFVO was closely linked to the shifts in HDA distribution, reflecting changes in stress distribution.