Spahn Gunter
Clinic of Arthroscopy and Joint Surgery Eisenach, Sophienstrasse 16, 99817 Eisenach, Germany.
Arch Orthop Trauma Surg. 2004 Dec;124(10):649-53. doi: 10.1007/s00402-003-0588-7. Epub 2003 Sep 30.
The high tibial (medial opening wedge) osteotomy (HTO) is a standard procedure in the treatment of varus gonarthrosis. This is potentially associated with various complications. The aim of this study was an analysis of complications and potential technical mistakes.
A total of 85 patients (49 male and 36 female) suffering from varus gonarthrosis underwent a medial opening wedge HTO. The osteotomy was fixed in 55 patients by a spacer plate (Puddu plate; group A). In group B (n=30), the osteotomies were fixed by C-plate.
The rate of complications was 43.6% in group A and 16.7% in group B (p<0.05). Infraction of the lateral tibial head is a possible intraoperative complication. This was seen in 11.7%. An additional osteosynthesis was required in group A. In contrast, the C-plate can solve this problem without additional measures. General complications of the HTO were seen: infection (4.7%), hematoma (4.7%), and thrombosis (2.3%). In every case of a severe deep infection, the osteotomy space was filled with synthetic bone graft. These grafts were used only in group A. Failure of the implants is a potential cause of loss of correction. This complication was seen nine times in group A but never in group B.
A diligent surgical technique and a convenient implant are obligatory in (medial opening wedge) HTO.
高位胫骨（内侧开口楔形）截骨术（HTO）是治疗膝内翻性膝关节病的标准手术。这可能会引发各种并发症。本研究的目的是分析并发症及潜在的技术失误。
共有85例（49例男性和36例女性）膝内翻性膝关节病患者接受了内侧开口楔形HTO手术。55例患者采用间隔钢板（普杜钢板；A组）固定截骨。B组（n = 30）采用C型钢板固定截骨。
A组并发症发生率为43.6%，B组为16.7%（p < 0.05）。胫骨外侧髁骨折是一种可能的术中并发症，发生率为11.7%。A组需要额外的骨固定。相比之下，C型钢板无需额外措施即可解决此问题。观察到HTO的一般并发症：感染（4.7%）、血肿（4.7%）和血栓形成（2.3%）。在每例严重深部感染病例中，截骨间隙用人工骨移植填充。这些移植仅在A组使用。植入物失败是矫正丢失的潜在原因。此并发症在A组出现9次，而在B组从未出现。
在（内侧开口楔形）HTO手术中，精细的手术技术和合适的植入物是必不可少的。
