Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome.
Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome.
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DOI：
10.1007/s00167-021-06717-2
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Hirschmann MT
中科院分区：
文献类型：
--
作者：
Schelker BL;Moret CS;Dogan O;Amsler F;Rasch H;Hügli RW;Hirschmann MT
本研究的目的是探讨术前SPECT/CT的特异骨示踪剂摄取(BTU)模式是否可以预测哪些内翻对齐和内侧超负荷的患者特别受益于内侧切开-楔形胫骨高位截骨术(MOWHTO)。其假说是，术前膝关节外侧和髌骨室SPECT/CT上股骨的BTU相对于基准BTU的增加是较差的临床结果的预测因素，并且临床结果与对齐矫正的程度相关。对因内侧筋膜室负荷过重而行MOWHTO术的22例患者的23个膝关节进行了术前~(99m)Tc-SPECT/CT检查。根据先前验证的方案，BTU被量化并定位到特定的关节区域。测量手术前后的机械对齐情况。通过收集WOMAC评分，在MOWHTO后的中位数24个月(范围11-30)评估临床结果。膝盖区BTU与WOMAC总分及其亚类疼痛和僵硬显著相关。因此，1sPAT区的BTU与总的WOMAC值(Rho = 0.43，p = 0.04)、疼痛亚类(Rho = 0.43，p = 0.04)和僵硬亚类(Rho = 0.59，p = 0.003)相关。在对齐矫正、年龄、性别和WOMAC之间没有发现显著的相关性。这项研究强调了术前SPECT在现代膝关节外科中的作用，以获得有关膝关节不同间隔区负荷模式的信息。尽管参与者数量有限，但本研究表明，如果考虑MOWHTO，术前SPECT/CT扫描可以帮助治疗外科医生确定哪些患者可能面临较差的临床结果，因为术前SPECT/CT显示的膝盖区BTU升高似乎是术后疼痛和僵硬的潜在危险因素。第三级。
The purpose of this study was to investigate whether specific bone tracer uptake (BTU) patterns on preoperative SPECT/CT could predict which patients with varus alignment and medial overload would particularly benefit from medial opening-wedge high tibial osteotomy (MOWHTO). It was the hypothesis that an increased preoperative BTU relative to the reference BTU of the femur on SPECT/CT in the lateral and patellar compartments of the knee are predictive factors for inferior clinical outcome and that the clinical outcome correlates with the extent of alignment correction. Twenty-three knees from 22 patients who underwent MOWHTO for medial compartment overload were investigated preoperatively using Tc-99m-SPECT/CT. BTU was quantified and localised to specific joint areas according to a previously validated scheme. Pre- and postoperative mechanical alignment was measured. Clinical outcome was assessed at a median of 24 months (range 11–30) after MOWHTO by collecting the WOMAC score. Significant correlations between BTU in the patellar area and the total WOMAC score and its subcategories pain and stiffness were found. Thus, BTU in the 1sPat area (superior lateral patellar compartment) correlated with total WOMAC (rho = 0.43, p = 0.04), pain subcategory (rho = 0.43, p = 0.04), and stiffness subcategory (rho = 0.59, p = 0.003). No significant correlations were found between alignment correction, age, gender and WOMAC. This study highlights the role of preoperative SPECT in modern knee surgery to obtain information about the loading pattern on different compartments of the knee. Despite the limited number of participants, the present study shows that a preoperative SPECT/CT scan can help the treating surgeons to identify patients who may be at risk of inferior clinical outcome if an MOWHTO is considered, as an elevated BTU in the patellar region on preoperative SPECT/CT appears to be a potential risk factor for postoperative pain and stiffness. Level III.
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