OrthoPilot导航下内侧开放楔形胫骨高位截骨
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苏州大学附属第一医院

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R684.3

基金项目:

PP2Ac磷酸化Bcl-2调控破骨细胞自噬在OA软骨下骨重建紊乱中的作用及机制研究


The OrthoPilot navigation system guides medial open wedge high tibial osteotomy
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Affiliation:

the First Affiliated Hospital of Soochow University

Fund Project:

The role and mechanism of osteoclast autophagy regulation involving Bcl-2 phosphorylated by PP2A in subchondral bone remodeling disorder of osteoarthritis

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    摘要:

    [目的] OrthoPilot导航下内侧开放楔形胫骨高位截骨(MOWHTO)的手术技术和初步临床结果。[方法] 2018年8月至2021年2月本院收治34例患者(44膝)。术前采用“截骨大师”进行规划,术中采用OrthoPilot导航注册,并按步骤截骨,通过导航量化机械轴及内翻角度的变化指导截骨。 [结果] 34例患者平均随访22.32±7.88月,末次随访HSS评分优于术前(P <0.001)。术前全长片力线经胫骨平台相对位置较导航注册后偏内(P <0.001),内翻更大(P <0.001);术后全长片较导航截骨后偏内(P <0.001),外翻更小(P =0.005)。术后全长片力线满意(位于50%~62.5%)27膝,不满意17膝;导航术中力线矫正量处于术前全长片矫正至50%~62.5%的矫正量范围内:满意组15膝、不满意组8膝(P =0.583);导航术中内翻矫正量处于术前全长片矫正至外翻0°~3°的矫正量范围内:满意组15膝、不满意组4膝(P =0.037)。[结论] OrthoPilot导航下MOWHTO可显著改善患者症状,且保持导航术中内翻矫正量与术前全长片矫正至外翻0°~3°的矫正量一致,可使术后力线更满意。

    Abstract:

    [Objective] To introduce the surgical technique and primary clinical results of medial open wedge high tibial osteotomy (MOWHTO) under Orthopilot navigation. [Methods] From August 2018 to February 2021, 34 patients (44 knees) were admitted to our hospital. Preoperative planning was performed with the “Osteotomy Master”. Registration was pefromed by OrthoPilot navigation intraoperatively, and then the osteotomy was done. The mechanical axis and varus angle were quantified by navigation to guide osteotomy. [Results] The follow-up time of 34 patients was (22.32±7.88) months. The HSS score of the last follow-up was significantly better than that before the operation (P<0.001). Compared with navigation after registered, the alignment of preoperative full-length radiographs was significantly more internal (P<0.001), and the varus was significantly greater (P<0.001). Compared with navigation after osteotomy, the alignment of postoperative full-length radiographs was significantly more internal (P<0.001), and the valgus was significantly smaller (P=0.005). There were 27 knees with satisfactory alignment on postoperative full-length radiographs, which is across 50%-62.5% of tibial plateau, and 17 knees were not satisfactory. There were 15 knees in the satisfactory group and 8 knees in the unsatisfactory group with no statistical significance (P=0.583), which the correction amount of alignment during navigation was within the range of the preoperative full-length radiographs corrected to 50%-62.5%. There were 15 knees in the satisfactory group and 4 knees in the unsatisfactory group with statistical significance (P=0.037), which the correction amount of varus during navigation was within the range of the preoperative full-length radiographs corrected to 0~3 degrees valgus. [Conclusion] MOWHTO guided by Orthopilot navigation can significantly relief symptoms. Making the correction amount of varus during navigation consistent with the range of the preoperative full-length radiographs corrected to 0~3 degrees valgus can resulting in a more satisfactory postoperative alignment.

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  • 收稿日期:2022-02-23
  • 最后修改日期:2022-05-30
  • 录用日期:2022-09-16
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