2024 · Clinical Biomechanics
開大式HTOと閉鎖式HTOで、歩行の変化は同じか？
内反矯正量に群間差はありませんでした（P = 0.543）。Opening-wedge群ではPTSが高く、Blackburne–Peel ratioが低値でした（ともにP < 0.001）。
研究構造
- 01対象
38人。
- 02方法
後ろ向き比較：OW 19人、CW 19人。初期・1年時の歩行解析と2年時の臨床・画像追跡を行いました。
- 03報告された結果
内反矯正量に群間差はありませんでした（P = 0.543）。Opening-wedge群ではPTSが高く、Blackburne–Peel ratioが低値でした（ともにP < 0.001）。
研究対象・方法・結果を分けて示した説明用の模式図です。論文の原図ではありません。
抄録の解説
対象と方法
主な結果
手術に関する読書のポイント
解釈の限界
簡単に説明しましょう
この研究で何が確認されましたか?
内反矯正量に群間差はありませんでした（P = 0.543）。Opening-wedge群ではPTSが高く、Blackburne–Peel ratioが低値でした（ともにP < 0.001）。
治療決定に直接適用できるか?
少数例の非無作為化コホート研究です。抄録の結果と解釈で矢状面の変化の方向に関する記述が一致しておらず、群ごとの数値は原著の表で確認する必要があります。短期のPFJ成績に差がなくても、長期成績が同等とはいえません。
Keywords・キーワード
- Closing wedge osteotomy
- Gait analysis
- High tibial osteotomy
- Open wedge osteotomy
- Osteoarthritis, Knee
- Retrospective Studies
- Treatment Outcome
- Knee Joint
Abstract・原文の抄録
Do Weon Lee, Hyuk-Soo Han, Du Hyun Ro. Comparative analysis of gait: Similar coronal but different sagittal effects between closing-wedge and opening-wedge high tibial osteotomy. Clinical biomechanics (Bristol, Avon). 2024;114:106238. doi:10.1016/j.clinbiomech.2024.106238.
BACKGROUND
High tibial osteotomy is an established surgical option for medial compartment osteoarthritis of the knee with varus alignment. It can be divided into open wedge and closing wedge by operative technique. Although they have fundamental differences, little is known about the biomechanical consequences of the two surgical methods.
METHODS
Thirty-eight patients with medial compartment osteoarthritis who underwent high tibial osteotomy (19 open-wedge and 19 closing-wedge) were retrospectively reviewed. Clinical scores and radiological measurements were assessed until postoperative two years. Gait analysis was performed preoperatively and again at postoperative one year.
FINDINGS
Varus alignment was corrected in both groups without a significant difference between them (p = 0.543). However, posterior tibial slope was higher, and the Blackburne-Peel ratio was lower in the open wedge osteotomy group after surgery (both p < 0.001). Reduction of dynamic knee varus and knee adduction moment were observed in both groups without significant differences. However, after surgery, average knee range of motion (63.3° vs 57.3°, p < 0.001) and the magnitude of knee flexion moment was significantly lower (p = 0.005) in the closing wedge group. There were no significant differences in the Kujala Anterior Knee Pain Scale and the occurrence of patellofemoral arthritis between the groups postoperatively.
INTERPRETATION
After osteotomy, a smaller average knee range of motion in the sagittal plane and a higher knee flexion moment were observed in the open wedge osteotomy group, suggesting quadriceps muscle avoidance. However, no differences in clinical scores or the short-term occurrence of patellofemoral arthritis were noted between the two surgical techniques.
オリジナル紙だ
Comparative analysis of gait: Similar coronal but different sagittal effects between closing-wedge and opening-wedge high tibial osteotomy
Do Weon Lee, Hyuk-Soo Han, Du Hyun Ro
Clinical Biomechanics · 2024