高位脛骨矯正術對退化性膝關節三維運動的影響

Abstract

退化性膝關節炎是一種常見的關節疾病之一，致病原因主要是膝關節在長期受力下造成關節軟骨退化磨損，進而產生關節疼痛和僵硬，甚至影響活動功能。目前治療退化性膝關節炎的手術方法有全膝關節置換術、單側膝關節置換術、高位脛骨矯正術等等。其中，高位脛骨矯正術是透過矯正下肢機械軸角度來達到減輕膝關節內側承重及減緩退化性膝關節炎惡化之目的。因其無須像關節置換術一般裝入植入物，因此手術後的膝關節面不會有所改變。然而，目前對於高位脛骨矯正手術前後相關的關節運動學參數變化以及手術對於活體膝關節生物力學表現之影響尚未有完整研究。 本研究結果發現，相同動作下，高位脛骨矯正手術對於關節角度產生最顯著的影響在於矢狀面的關節活動度增加，且在相同膝關節屈曲角度下，手術後冠狀面的外展角度顯著增加，符合手術對下肢機械軸所造成的改變。在功能性動作過程中，相同膝關節屈曲角度下，高位脛骨矯正手術使得膝關節內側之平均關節內間距顯著增加、膝關節內側之表面接觸面積顯著變小，且膝關節內側之表面接觸點顯著往後側移動。 本研究結果呈現之退化性膝關節炎患者在接受高位脛骨矯正術前後於功能性動作過程中的運動學量化資訊，其有助於瞭解該手術對膝關節及其運動學表現造成的改變。本研究之結果不僅能作為手術效果評估之參考，亦能提供治療與後續復健計畫評估所需的重要訊息。

Knee osteoarthritis (OA) is one of the common joint diseases caused by articular cartilage degeneration which causes joint pain, joint stiffness and affect the joint movement. The current treatments for knee OA include total or unilateral knee arthroplasty and high tibial osteotomy (HTO). Unlike the arthroplasty, HTO surgery neither requires implants nor alters the articular surface. However, the related changes of in vivo knee kinematic pre and post HTO surgery have not been fully studied. Obtaining quantitative kinematic of patients with knee OA pre and post HTO provides necessary knowledge for the surgery outcome assessment, as well as the planning and evaluation of subsequent treatment and rehabilitation programs. The finding of the current research are as follows, the range of motion on sagittal plane and abduction angles are significantly increased during some functional activities, which corresponded with the alignment change of tibia after HTO surgery. The surgery also affected the mean inter-articular distance, the contact area and the position of the articular contact points on tibial plateau of medial compartment of knee joint during functional tasks. The finding presented in the current study of patients with knee OA during functional activities pre and post HTO surgery can provide a better understanding of the effect of HTO surgery on the knee joint kinematics and biomechanics, which can be helpful for surgery outcome assessment and future rehabilitation planning.