行胫骨高位截骨术患者的全腿站立x线片和Rosenberg视图的胫骨内侧近端角度测量比较。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-07-01 DOI:10.1016/j.jisako.2025.100920

Moses KD. El Kayali MD , Lorenz Pichler MD , Clemens Gwinner MD , Rosa Berndt MD

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引用次数: 0

摘要

简介/目的：内侧开楔形胫骨高位截骨术（MOW-HTO）是膝关节内侧骨室骨关节炎（OA）的标准治疗方法。它的成功依赖于精确的术前计划，通常使用全腿站立x线片（FLSR）进行冠状位对齐评估。然而，膝关节屈曲和旋转等因素会影响对齐测量。罗森博格影像（RB），通常用于OA评估，可能在术前规划中提供额外的价值。本研究调查了内侧胫骨近端角（MPTA）测量在RB和FLSR之间是否存在差异，假设两种方法都能产生可比的测量结果。方法：本回顾性队列研究纳入60例诊断为内侧室骨关节炎的患者，计划进行MOW-HTO。由两名观察员在RB和FLSR x线片上测量MPTA。采用类内相关系数（ICC）评估组间信度，采用Pearson相关和Student’st检验比较两种测量方法的MPTA均值。报告了测量值超过临床可接受阈值3°的百分比。生成Bland-Altman图来评估一致性。结果：平均MPTA为86.0°±1.8°(95% CI, 85.55；86.46])和85.1°±1.6°(95% CI, [84.70；85.50])，平均差为0.9°±2.41°(95% CI, [0.29；1.51])，两种治疗方式差异有统计学意义(p < 0.001；Cohen’s d = 0.53)。60例中51例（85%）的差异保持在3°的阈值内，9例（15%）超过该阈值。Pearson相关分析显示MPTA测量RB与FLSR呈正相关（r = 0.53, p < 0.001）。Bland-Altman分析显示95%的一致性范围为-3.61°至+5.41°。结论：本研究发现证据水平和研究设计存在较小的统计学差异：III级，队列研究。

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Comparable medial proximal tibial angle measurements on full-leg standing radiographs and the Rosenberg view in patients undergoing high tibial osteotomy

Introduction/objectives

Medial open wedge high tibial osteotomy (MOW-HTO) is a standard treatment for medial compartment osteoarthritis (OA) of the knee. Its success relies on precise preoperative planning, typically using full-leg standing radiographs (FLSR) for coronal alignment assessment. However, factors like knee flexion and rotation can influence alignment measurements. The Rosenberg view (RB), commonly used for OA assessment, may offer additional value in preoperative planning. This study investigates whether the medial proximal tibial angle (MPTA) measurements differ between RB and FLSR, hypothesizing that both methods yield comparable measurements.

Methods

This retrospective cohort study included 60 patients diagnosed with medial compartment osteoarthritis scheduled for MOW-HTO. MPTA was measured on both RB and FLSR radiographs by two observers. Interrater reliability was assessed using intraclass correlation coefficients, while Pearson correlation and Student’s t-test were used to compare MPTA means between the two measurement techniques. The percentage of measurements exceeding a clinically acceptable threshold of 3° was reported. A Bland–Altman plot was generated to evaluate agreement.

Results

The mean MPTA was 86.0° ± 1.8° (95% CI: [85.55; 86.46]) on RB and 85.1° ± 1.6° (95% CI: [84.70; 85.50]) on FLSR, with a mean difference of 0.9° ± 2.41° (95% CI: [0.29; 1.51]), showing a statistically significant difference between the two modalities (p < 0.001; Cohen’s d = 0.53). In 51 of 60 cases (85%), the difference remained within the threshold of 3°, while 9 cases (15%) exceeded this threshold. Pearson correlation analysis demonstrated a strong positive correlation between MPTA measurements on RB and FLSR (r = 0.53, p < 0.001). Bland–Altman analysis revealed 95% limits of agreement ranging from −3.61° to +5.41°.

Conclusion

This study found a small, statistically significant difference of <1.0° between MPTA measurements from RB and FLSR, which was not clinically relevant as 85% of cases were within the threshold of 3°. A strong correlation and good agreement on Bland–Altman analysis support the comparability of both methods. RB may therefore serve as a viable alternative for both diagnosis and preoperative planning in MOW-HTO, potentially reducing the need for additional FLSR in resource-limited settings while also minimizing radiation exposure.