腓骨截骨术治疗膝关节内侧间室骨关节炎的2D-3D影像学和在体生物力学研究

Fibulatomy is a new method for the treatment of primary medial compartment osteoarthritis (OA) of the knee joint and its validity has been clinically proved. However, the treatment mechanism and indication of this approach are still uncertain. In order to address these questions, this project intend to recruit patients with primary medial compartment osteoarthritis of the knee joint and perform fibulatomy on them as the treatment for OA. Radiographs of lower extremities of the patients will be taken while wearing radiopaque calibration devices preoperatively and 6, 12, and 24 months post-operatively. Two- and three-dimensional measurements including medial and lateral joint space, lower extremity force line and femoro-tibial anatomical axis angle will be measured on 2D X-ray images and 3D models produced by statistical shape modeling technique, and inverse dynamic simulation and finite element simulation will be performed using these measurements to obtain individual mechanical distribution information of the knee joint and its surrounding muscles. Comparison of preoperative and postoperative data will be performed, and their relevance to the clinical manifestations of the patients will be analyzed, to carry out quantitative evaluation and biomechanical follow-up of the efficacy of the surgery and establish the relation of imaging anatomical changes, biomechanical changes and clinical outcomes, in order to illustrate the mechanism and specific indication of fibulatomy in treatment of medial compartment OA of the knee joint, thereby providing scientific evidence to support the extending use of this new method.

腓骨截骨术是治疗膝关节内侧间室骨关节炎的新手段，其有效性已得到临床验证，但其作用机理和应用指征尚不明确。针对这一问题，本研究拟以原发性膝关节内侧间室骨关节炎患者为研究对象，于腓骨截骨术前和术后6、12、24个月，应用X线显影的标定装置和统计形状建模技术实现二维X线图像采集和三维重建，精确测量二维和三维关节内外侧间隙、下肢力线、股骨胫骨解剖轴夹角等解剖参数，并进行个体化逆向动力学仿真和有限元仿真分析，获得膝关节及周围肌肉的力学分布数据。通过分析手术前后上述数据的变化及其与患者临床表现的相关性，对腓骨截骨术的功效进行量化评估和整体生物力学随访，并建立影像学改变、生物力学改变和临床转归之间的联系，从而明确腓骨截骨术治疗膝关节内侧间室骨关节炎的机理和应用指征，为该术式的推广提供科学依据。

腓骨截骨术用于治疗膝关节内侧骨关节炎是传统术式的创新应用，其理论基础是由张英泽院士于2015年提出的腓骨支撑导致胫骨平台不均匀沉降是膝关节关节炎的决定性因素。本课题以原发性膝关节内侧间室骨关节炎患者为研究对象，通过对于临床评价，膝关节内侧关节间隙、接触面、下肢力线角度、肌肉韧带伸长等生物力学参数测量，对比腓骨截骨术前和术后，客观评价腓骨截骨术治疗膝关节内侧间室骨关节炎的功效。本课题结果显示，腓骨截骨术前患者的VAS 评分分别为5.99±1.38，术后6、12、24个月随访时分别为 3.24±0.96、2.46±0.89、2.23±0.91，较术前均有显著降低（P<0.05）；膝关节功能评分术前为50.1±16.0，术后6、12、24个月随访时分别为71.4±14.2、73.8±12.6、74.6±14.7，较术前均有显著提高（P<0.05）。开发了多维X线个体化3D建模技术并获得了1mm级建模精度；开发了3D关节间隙测量技术，改进了2D X光片受拍摄角度影响大、主观测量误差等缺点；开发了3D下肢力线测量技术，改进了2D力线透视投影误差的不足。通过上述技术，我们验证了关节内侧间室术后间隙增大，内外两侧间室间隙趋向于均匀；下肢力线角度得到矫正；接触面趋于平缓；肌肉韧带趋向于正常生理状态。本研究为深入探索腓骨截骨术治疗膝关节内侧间室骨关节炎的作用机理，从而为该术式的推广提供了科学依据。课题组成员参加4次国际国内会议并发言，发表2篇学术论文，将研究成果向国内外推广。