rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-233-241rsp-3157Research ArticleРЕВМООРТОПЕДИЯ И РЕАБИЛИТАЦИЯORTHOPEDIC RHEUMATOLOGY AND REHABILITATIONЧто может повлиять на результат медиальной открывающей угол высокой тибиальной остеотомии?What can influence the outcome of open wedge high tibial osteotomy?https://orcid.org/0000-0002-3745-0924БяликВ. Е.BialikV. E.

Бялик Валерий Евгеньевич

115522, Москва, Каширское шоссе, 34а

Valerii E. Bialik

115522, Moscow, Kashirskoye Highway, 34A

DoctorBjalik@yandex.ruhttps://orcid.org/0000-0001-8563-0631МакаровС. А.MakarovS. A.

115522, Москва, Каширское шоссе, 34а

Sergey A. Makarov

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-5626-7404МакаровМ. А.MakarovM. A.

115522, Москва, Каширское шоссе, 34а

Maxim A. Makarov

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-7938-1536БяликЕ. И.BialikE. I.

115522, Москва, Каширское шоссе, 34а

Evgeny I. Bialik

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-7179-8174НестеренкоВ. А.NesterenkoV. A.

115522, Москва, Каширское шоссе, 34а

Vadim A. Nesterenko

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-6847-6396НурмухаметовМ. Р.NurmukhametovM. R.

115522, Москва, Каширское шоссе, 34а

Maxim R. Nurmukhametov

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-0454-0974КапитоновД. В.KapitonovD. V.

115522, Москва, Каширское шоссе, 34а

Daniil V. Kapitonov

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-5256-7346ЧерниковаА. А.ChernikovaA. A.

109004, РосМосква, Товарищеский пер., 10, стр. 2

Anastasia A. Chernikova

109004, Moscow, Tovarishcheskiy lane, 10, building 2

ФГБНУ Научно-исследовательский институт ревматологии им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationКлиника Креде Эксперто, ОООРоссияLLC Crede Experto ClinicRussian Federation202214052022602233241Copyright © Бялик В.Е., Макаров С.А., Макаров М.А., Бялик Е.И., Нестеренко В.А., Нурмухаметов М.Р., Капитонов Д.В., Черникова А.А., 20222022Бялик В.Е., Макаров С.А., Макаров М.А., Бялик Е.И., Нестеренко В.А., Нурмухаметов М.Р., Капитонов Д.В., Черникова А.А.Bialik V.E., Makarov S.A., Makarov M.A., Bialik E.I., Nesterenko V.A., Nurmukhametov M.R., Kapitonov D.V., Chernikova A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3157

Цель исследования – изучить влияние пациент-специфических показателей (возраст, индекс массы тела (ИМТ), стадия остеоартрита (ОА) коленного сустава (КС)), высоты остеотомического клина, сопутствующих медиальной открывающей угол высокой тибиальной остеотомии (МОУВТО) вариантов артроскопической пластики (АП) и открытой хондропластики (ОХП) на развитие осложнений и результат операции.

Материалы и методы

Материалы и методы. В исследование включены 76 пациентов, которым была выполнена МОУВТО. Для изучения влияния каждого из параметров были созданы группы сравнения: 1) по возрасту: моложе (n=45) и старше (n=31) 60 лет; 2) по ИМТ: <30 кг/м2 и ≥30 кг/м2; 3) по высоте раскрытия остеотомического клина: ниже (n=29) и выше (n=47) 10 мм; 4) по стадиям ОА: с I и II стадиями (n=43) и с III стадией (n=33); 5) по характеру оперативного вмешательства: МОУВТО + АП КС или ОХП (n=34) и изолированная МОУВТО (n=42). Для оценки результата изучали изменение интенсивности боли по визуальной аналоговой шкале (ВАШ), а также состояние КС по шкале Knee Society Score (KSS) до операции и через 1 год после МОУВТО.

Результаты

Результаты. Развитие осложнений имело слабую прямую связь с III стадией ОА КС (r=–0,24) и умеренной силы прямую связь с высотой раскрытия остеотомического клина >10 мм (r=–0,42). Возраст, ИМТ, наличие сопутствующих АП КС и ОХП не оказывало влияния на развитие осложнений. Однако число осложнений было статистически значимо выше среди пациентов с III стадией и высотой остеотомического клина >10 мм, чем при II стадии ОА КС (р=0,03) и высоте клина ≤10 мм (р=0,0002). Возраст старше 60 лет и ИМТ<30 кг/м2 имели прямую слабую связь (r=0,27 и r=0,23 соответственно) с достижением удовлетворительного результата. Напротив, отличный результат ассоциировался с ИМТ<30 кг/м2 и I–II стадиями ОА КС (r=0,34 и r=0,31 соответственно), а также имел прямую умеренной силы связь с высотой остеотомического клина ≤10 мм (r=0,46). У пациентов старше 60 лет удовлетворительный результат МОУВТО встречался статистически значимо чаще, чем у больных молодого и среднего возраста (р=0,016). 71,1% отличных результатов были получены у пациентов с ИМТ<30 кг/м2 (р=0,002), а хороших и удовлетворительных результатов было статистически значимо больше в группе больных с ИМТ≥30 кг/м2 (р=0,08 и р=0,04 соответственно). При III стадии ОА отличный результат отмечался в 3 раза реже, чем у больных с I и II стадиями (р=0,004). У пациентов с раскрытием клина ≤10 мм отличных результатов было в 1,5 раза больше, чем у больных с высотой клина >10 мм (р=0,00006). Результаты изолированной МОУВТО и МОУВТО, выполнявшейся в сочетании с АП КС или ОХП, существенно не различались.

Выводы

Выводы. Развитие осложнений МОУВТО ассоциировано с III стадией ОА КС и высотой раскрытия остеотомического клина >10 мм. Лучший результат МОУВТО может быть получен у пациентов в возрасте до 60 лет, с ИМТ<30 кг/м2, I–II стадиями ОА КС и при коррекции деформации в пределах 10 мм. Выполнение сопутствующей АП КС или ОХП не оказывает влияния на развитие осложнений и результат операции.

Objective – to assess the effect of patient-specific parameters (age, body mass index (BMI), stage of the knee osteoarthritis (KOA), the osteotomy gap size, concomitant medial opening angle high tibial osteotomy (MOWHTO) arthroscopic plastic (AP) and open chondroplasty (OCHP) on the development of complications and the outcome of the operation.

Materials and methods

Materials and methods. The study included 76 patients who underwent MOWHTO. To study the influence of each of the parameters, comparison groups were created: 1) by age: patients younger and older than 60 years (45 versus 31); 2) by BMI: patients with BMI<30 kg/m2 versus patients with a BMI from 30 to 40 kg/m2 (35 versus 41); 3) by the osteotomy gap size: ≤10 mm and >10 mm (29 versus 47); 4) by stages of KOA: patients with stage I and II versus patients with stage III (43 versus 33); 5) patients with MOWHTO + AP of the knee or OCHP versus patients who underwent only MOWHTO (34 versus 42). To assess the result, we studied the change in pain intensity according to the visual analogue scale (VAS), as well as the state of the knee joint according to the Knee Society Score (KSS) scale before surgery and 1 year after MOWHTO.

Results

Results. The development of complications had a weak direct relationship with stage III of the KOA (r=–0.24) and moderate strength a direct relationship with the osteotomy gap size >10 mm (r=–0.42). Age, BMI, the presence of concomitant AP of the knee or OCHP did not affect the development of complications. However, the number of complications was statistically significantly higher among patients with stage III and osteotomy gap size >10 mm relative to patients with stage II of the KOA (p=0.03) and patients with deformity correction ≤10 mm (p=0.0002). Age over 60 years and BMI<30 kg/m2 had a direct weak relationship (r=0.27 and r=0.23) with the achievement of a satisfactory result. An excellent result had a direct weak relationship with a BMI<30 kg/m2 and stages I–II of the KOA (r=0.34 and r=0.31), as well as a direct moderate strength relationship with an osteotomy gap size ≤10 mm (r=0.46). At the age of patients over 60 years, a satisfactory result was significantly more frequent compared with patients of young and middle age (p=0.016). 71.1% of excellent results were obtained in patients with a BMI<30 kg/m2 (p=0.002), and there were significantly more good and satisfactory results in the group of patients with a BMI>30 kg/m2 (p=0.08 and p=0.04). At stage III, an excellent result was obtained 3 times less frequently than in patients with stages I and II of the KOA (p=0.004). In patients with gap size ≤10 mm, excellent results were 1.5 times greater than in patients with a gap size >10 mm (p=0.00006). There were no differences in the results in patients who underwent MOWHTO in isolation and in patients in whom MOWHTO was supplemented with AP of the knee or OCHP.

Conclusions

Conclusions. The development of complications is associated with stage III of the KOA and the need for correction (the osteotomy gap size) >10 mm. The best result of MOWHTO can be obtained in patients under the age of 60 years, with a BMI <30 kg/m2 at stages I–II of the KOA and deformity correction within 10 mm. Concomitant AP of the knee or OCHP don’t affect the development of complications and the outcome of the operation.

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The authors declare that there are no conflicts of interest present.