Background:If an increased posterior tibial slope (PTS) and concomitant unicompartmental osteoarthritis are present, a simultaneous sagittal (slope) and coronal correcting high tibial osteotomy has been recommended. However, no study has investigated the accuracy of such combined high tibial slope correction osteotomies.Purpose:(1) To report the accuracy of navigated high tibial slope correction osteotomies using patient-specific instruments (PSI) and (2) to analyze the influence of an open wedge osteotomy (OWO) versus a closed wedge osteotomy (CWO) and the hinge axis angle (HAA) on the accuracy of the PTS correction.Study Design:Cohort study; Level of evidence, 3.Methods:All PSI PTS-reducing osteotomies performed at 1 institution between 2019 and 2022 were reviewed. Three-dimensional (3D) accuracy was defined as the mean absolute 3D angular difference between the planned and achieved surgical correction (in degrees) in 3D models of computed tomography data. The influence of OWO versus CWO and the HAA on the reported accuracy was analyzed and a cutoff defined using receiver operating characteristic curve analysis.Results:Eighteen patients who underwent a slope-reducing CWO (n = 9) or OWO (n = 9) were included. The 3D accuracy for PTS was 2.3°± 1.1° (mean ± SD), with CWO being more accurate than OWO (1.4°± 0.9° vs 3.1°± 0.6°; P < .01). Accuracy strongly correlated with the HAA ( r = 0.788; P < .01). An HAA >38.9° predicted a PTS error >2° (odds ratio, 1.12 [95% CI, 1.04-1.20; P = .004]; area under the curve, 0.95 [95% CI, 0.89-1.00; P < .001]) corresponding to a coronal/sagittal correction of 0.8:1.Conclusion:Slope-reducing osteotomy can accurately be achieved using PSI. CWO demonstrated an increased accuracy when compared with OWO, which strongly depended on the HAA. With an aim of combined PTS and coronal correction, CWO should be considered the primary choice for accurate slope reduction with a coronal/sagittal correction cutoff of 0.8:1 (HAA, 38.9°).

中文翻译：

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使用 3 维计划的患者特定器械进行联合胫骨高斜率矫正截骨术的准确性


背景： 如果存在胫骨后斜率 （PTS） 增加和伴随的单髁骨关节炎，建议同时进行矢状面 （斜率） 和冠状面矫正胫骨高位截骨术。然而，没有研究调查这种联合胫骨高斜率矫正截骨术的准确性。目的： （1） 报告使用患者专用仪器 （PSI） 导航胫骨高斜矫正截骨术的准确性，以及 （2） 分析开放楔形截骨术 （OWO） 与封闭楔形截骨术 （CWO） 和铰链轴角 （HAA） 对 PTS 矫正准确性的影响。研究设计： 队列研究;证据水平， 3.方法： 回顾了 2019 和 2022年在 1 个机构进行的所有 PSI PTS 降低截骨术。三维 （3D） 精度定义为计算机断层扫描数据的 3D 模型中计划和实现的手术矫正（以度为单位）之间的平均绝对 3D 角度差。分析 OWO 与 CWO 和 HAA 对报告准确性的影响，并使用受试者工作特征曲线分析定义临界值。结果： 纳入 18 例接受降斜率 CWO （n = 9） 或 OWO （n = 9） 的患者。PTS 的 3D 精度为 2.3°± 1.1°（标清±平均值），其中 CWO 比 OWO 更准确（1.4°± 0.9° 对 3.1°± 0.6°;P < .01）.准确性与 HAA 密切相关 （r = 0.788;P < .01）.HAA >38.9° 预测 PTS 误差 >2° （比值比，1.12 [95% CI，1.04-1.20;P = .004];曲线下面积，0.95 [95% CI，0.89-1.00;P < .001]） 对应于 0.8：1 的冠状面/矢状面矫正。结论： 使用 PSI 可以准确实现斜率缩小截骨术。 与严重依赖 HAA 的 OWO 相比，CWO 表现出更高的准确性。为了实现 PTS 和冠状面矫正的联合，应将 CWO 视为准确降低斜率的首选，冠状面/矢状面矫正临界值为 0.8：1 （HAA， 38.9°）。