合理的铰链位置预防开楔胫骨远端粗隆截骨术中铰链骨折

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-05-19 DOI:10.1002/jeo2.70278

Atsuki Tanaka, Daisuke Araki, Takahiro Yamashita, Shohei Sano, Ryo Okada, Mitsuhiko Takahashi, Yasushi Hashimoto

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引用次数: 0

摘要

目的开放楔形胫骨远端结节截骨术是治疗膝内翻性骨关节炎的有效方法。铰链骨折是主要并发症，而铰链位置是一个影响因素。本研究旨在探讨铰链位置与骨折之间的关系。方法对42例行owDTO的膝关节进行检查。术后计算机断层扫描（CT）图像测量铰链区域周围的距离和角度，研究近端胫腓关节（PTFJ）铰链骨折的水平。根据先前的报道，对铰链位置进行分类，并对铰链骨折进行评估。结果无病例位于PTFJ上方，41例位于PTFJ内，1例位于PTFJ远端。铰链骨折10例（23.8%）。根据铰链位置分类，I型（PTFJ内骨折）7例，II型（PTFJ远端骨折）3例，III型（关节内骨折）无一例。轴向CT图像上垂直于PTFJ近端法兰下降切口的前后铰链宽度在铰链骨折组中明显较短（p = 0.03）。在我们的研究中，owDTO铰链骨折率与之前的开放楔形胫骨高位截骨报道相当。由于铰链骨折的风险随着前后铰链宽度的缩短而增加，我们的研究结果表明，保留前后铰链宽度可能有助于减少铰链骨折。证据等级III级，回顾性研究。

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Appropriate hinge position to prevent hinge fracture in open wedge distal tuberosity tibial osteotomy

Purpose

Open wedge distal tuberosity tibial osteotomy (owDTO) is an effective treatment for varus knee osteoarthritis. Hinge fracture is a major complication, and hinge position is a contributing factor. This study aimed to investigate the relationship between hinge position and fractures.

Methods

This study examined 42 knees that underwent owDTO. The level of the proximal tibiofibular joint (PTFJ) hinge fracture was investigated on postoperative computed tomography (CT) images measuring the distances and angles around hinge area. Based on previous reports, the hinge position was classified, and hinge fractures were assessed.

Results

No cases were found with a hinge position above PTFJ, 41 cases were within PTFJ, and one case was distal to PTFJ. Hinge fractures were observed in 10 patients (23.8%). According to the hinge position classification, seven cases were type I (a fracture within PTFJ), three were type II (a fracture that reaches the distal portion of PTFJ), and no cases were type III (intra-articular fracture). The anteroposterior hinge width measured perpendicular to the descending cut of the flange on axial CT images at the proximal level of the PTFJ was significantly shorter in the hinge fracture group (p = 0.03).

Discussion

The owDTO hinge fracture rate in our study was comparable to that in previous reports on open wedge high tibial osteotomy. As the risk of hinge fracture increases with the shortening of the anterior-posterior hinge width, our results indicate that preservation of the anterior-posterior hinge width may help reduce hinge fractures.