关键词: 膝关节骨性关节炎, 内侧开放楔形胫骨高位截骨术, 个性化截骨导板, 膝关节功能, 前交叉韧带

Abstract: Objective To explore the application effect of personalized osteotomy guide plate in high tibial osteotomy for patients with knee osteoarthritis (KOA).Methods A total of 99 patients with KOA who underwent open wedge high tibial osteotomy (OWHTO) in our hospital from January 2022 to January 2023 were selected and randomly divided into a study group (50 cases) and a control group (49 cases) using a random number table method.The control group received traditional medial OWHTO treatment,and the study group received a combination of medial OWHTO and personalized osteotomy guide plate treatment.The indexes of operation and postoperative rehabilitation,serum inflammatory stress factor [C-reactive protein (CRP),tumor necrosis factor-α (TNF-α),cortisol (Cor),adrenocorticotropin (ACTH)],anatomical structure of knee joint [tibial plateau posterior Angle (PTSA),proximal medial tibial Angle (MPTA),hip knee ankle Angle (HKA)],knee function,ACL shape and function,postoperative complications were compared between the two groups.Results The amount of bleeding,the number of intraoperative fluoroscopy,and the postoperative drainage volume in the study group were (138.69±24.03) ml,(4.83±1.07) times,and (228.95±38.72) ml,respectively,which were all less than those in the control group (154.28±27.16) ml,(7.15±1.14) times,and (271.61±42.19) ml.In the study group,the operation time,incision length,and hospitalization time were (40.96±7.28) min,(8.96±0.85) cm,and (10.73±2.05) d,respectively,which were all shorter than those in the control group [(52.31±10.12) min,(9.51±1.03) cm,and (12.16±2.37) d],with statistically significant differences (P<0.05).The levels of serum CRP,TNF-α,Cor,and ACTH in the study group on the 3rd day after the operation were (31.36±4.68) mg/L,(26.71±3.84) ng/ml,(241.28±27.45) ng/ml,and (18.65±3.01) pmol/L,respectively,which were lower than those in the control group [(35.07±5.16) mg/L,(30.29±4.15) ng/ml,(279.65±30.12) ng/ml,and (21.73±3.28) pmol/L,respectively],and the differences were statistically significant (P<0.05).The Hospital for Special Surgery(HSS) knee score and Knee Society Score(KSS) of the study group at 12 months after surgery were (81.24±6.85) points and (78.26±6.14) points,respectively,which were higher than those of the control group [(78.08±6.42) points and (75.53±5.82) points,respectively],with statistically significant differences (P<0.05);at the 12th month after surgery,the width of the ACL body in the study group was (5.68±0.71) mm,which was greater than that in the control group [(5.12±0.64) mm].The amount of anterior tibial displacement was (5.81±0.43)mm,which was smaller than that in the control group (6.19±0.41)mm,and the differences were statistically significant (P<0.05);the incidence of postoperative complications in the study group was 4.00%,which was lower than that in the control group (18.37%),and the difference was statistically significant (P<0.05).Conclusion The combined treatment of medial OWHTO and personalized osteotomy guide plate can reduce surgical trauma in patients with KOA,lower the incidence of complications,facilitate patient recovery,while maintaining the morphology and function of the ACL,and improving prognosis.

Key words: knee osteoarthritis, medial open wedge high tibial osteotomy, personalized osteotomy guide plate, anterior cruciate ligament, knee joint function