[1]韩月宁 李承思 邢欣 于腾波 赵阔 杨政伟 刘明辉 耿倩7.膝关节骨性关节炎行开放楔形胫骨高位截骨术后膝关节僵硬的预测因素[J].中华老年骨科与康复电子杂志,2025,(05):280-286.[doi:10.3877/cma.j.issn.2096-0263.2025.05.003]
　Han Yuening?,Li Chengsi?,Xing Xin?,et al.Predictive factors for knee stiffness after open-wedge high tibial osteotomy in patients with knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2025,(05):280-286.[doi:10.3877/cma.j.issn.2096-0263.2025.05.003]
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膝关节骨性关节炎行开放楔形胫骨高位截骨术后膝关节僵硬的预测因素()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2025年05
页码:
280-286
栏目:
关节炎
出版日期:
2025-10-05

文章信息/Info

Title:
Predictive factors for knee stiffness after open-wedge high tibial osteotomy in patients with knee osteoarthritis
作者:
韩月宁1 李承思2 邢欣2 于腾波3 赵阔4 杨政伟5 刘明辉6 耿倩7
300071 天津，南开大学经济与社会发展研究院医学管理系1 ?；050051 石家庄，河北医科大学第三医院，河北省骨科研究所2；266003 青岛大学附属医院骨科3；050051 石家庄，河北医科大学第三医院创伤急救中心4；402360 重庆市大足区中医院骨科5 ??；300121 天津市人民医院骨科6；050051 石家庄，河北医科大学第三医院护理部7
Author(s):
Han Yuening?;  Li Chengsi?;  Xing Xin?;  Yu Tengbo?;  Zhao Kuo4;  Yang Zhengwei5;  Liu Minghui6;  Geng Qian7.
?Department of Medical Management, Institute of Economic and Social Development, Nankai University, Tianjin 300071, China; ?Hebei Institute of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; ?Department of orthopedics, The Affiliated Hospital of Qingdao University, Qingdao 266003, China; 4Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; 5Department of orthopedics, Dazu District Hospital of Traditional Chinese Medicine, Chongqing 402360, China; 6Department of orthopedics, Tianjin People’s Hospital, Tianjin 300121, China; 7Nursing Department, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Keywords:
Knee osteoarthritis;  High tibial osteotomy;  Stiffness;  Predictive factors
DOI:
10.3877/cma.j.issn.2096-0263.2025.05.003
文献标志码:
A
摘要:
目的 开放楔形胫骨高位截骨术（OW-HTO）后膝关节僵硬，会显著影响手术治疗效果。然而，目前关于OW-HTO术后膝关节僵硬预测因素的研究仍较为缺乏。方法 采用回顾性队列研究设计，纳入2023年至2024年间首次接受OW-HTO治疗的患者，收集患者的人口统计学资料、Kellgren-Lawrence分级、髋-膝-踝（HKA）角、胫骨内侧平台沉降值、内固定物尺寸、植骨类型以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）。研究的结局是以术后1年WOMAC僵硬评分变差以及随访评估僵硬症状共同定义的“术后膝关节僵硬”。通过单因素分析和多因素Logistic回归分析探究术后僵硬的独立预测因素。结果 本研究共纳入527例患者，其中男性193例、女性334例，平均年龄为（59.5±6.7）岁。术后1年随访结果显示，91例（17.3%）患者出现膝关节术后僵硬。单因素分析表明：性别、体重指数（BMI）、糖尿病病史、术前HKA角、术前胫骨内侧平台沉降值、术前WOMAC僵硬评分、内固定物尺寸及植骨类型，均与术后僵硬存在关联。将上述变量纳入多因素Logistic回归分析，经向后逐步回归法筛选后发现：BMI（OR=1.23，95% CI：1.14，1.32，P＜0.001）、胫骨内侧平台沉降值（OR=1.23，95% CI：1.12，1.35，P＜0.001）、内固定物尺寸（OR=1.02，95% CI：1.01，1.03，P＜0.001）及推进骨瓣植骨（OR=0.24，95% CI：0.13，0.41，P＜0.001），是术后膝关节僵硬的独立预测因素。结论 对于接受OW-HTO的患者，高BMI与较大的胫骨内侧平台沉降值是术后膝关节僵硬的危险因素；而选择小尺寸内固定物及采用推进骨瓣植骨方式，可降低术后僵硬发生风险。临床中，应对高风险人群加强围术期管理，并在手术方式选择与内固定物选型方面优化策略。
Abstract:
Objective Postoperative knee stiffness following open-wedge high tibial osteotomy (OW-HTO) can significantly compromise surgical outcomes. However, there is a paucity of research investigating the predictive factors for knee stiffness after OW-HTO. Methods This was a retrospective cohort study involving patients who underwent primary OW-HTO between 2023 and 2024. Demographic data, Kellgren-Lawrence grade, hip-knee-ankle (HKA) angle, medial tibial plateau settlement value, size of internal fixation, type of bone graft, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected. The primary outcome was "postoperative knee stiffness," defined as a worsening of the WOMAC stiffness score at 1 year postoperatively combined with the presence of stiffness symptoms during follow-up evaluations. Univariate analysis and multivariate logistic regression analysis were used to identify independent predictive factors for postoperative stiffness. Results A total of 527 patients were included, with 193 males and 334 females, and a mean age of 59.5 years. At 1 year postoperatively, 91 (17.3%) patients developed postoperative knee stiffness. Univariate analysis showed that sex, body mass index (BMI), history of diabetes mellitus, preoperative HKA angle, preoperative medial tibial plateau settlement value, preoperative WOMAC stiffness score, size of internal fixation, and type of bone graft were associated with postoperative stiffness. After including variables in the multivariate logistic regression and applying backward stepwise regression for selection, BMI (OR=1.23, 95% CI: 1.14, 1.32, P<0.001), medial tibial plateau settlement value (OR=1.23, 95% CI: 1.12, 1.35, P<0.001), size of internal fixation (OR=1.02, 95% CI: 1.01, 1.03, P<0.001), and advancement bone flap grafting (OR=0.24, 95% CI: 0.13, 0.41, P<0.001) were identified as independent predictive factors for postoperative stiffness. Conclusions In patients undergoing OW-HTO, higher BMI and a larger medial tibial plateau settlement value are risk factors for postoperative knee stiffness, while using smaller-sized internal fixations and advancement bone flap grafting can reduce the risk of postoperative stiffness. Strengthening perioperative management in high-risk populations and optimizing surgical techniques and internal fixation selection may reduce the progression of stiffness and improve functional outcomes.

备注/Memo

备注/Memo:
基金项目：河北省省级科技计划资助（225A7703D）
更新日期/Last Update: 2026-05-18