Esenkaya Irfan, Elmali Nurzat
School of Medicine, Department of Orthopaedics and Traumatology, Inonu University, 44065 Malatya, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2006 Oct;14(10):955-61. doi: 10.1007/s00167-006-0075-0. Epub 2006 Mar 28.
We evaluated in this study indications, surgical technique, and results of wedge plates for fixation in proximal tibia medial opening wedge osteotomy. Fifty-eight knees in 56 consecutive patients (9 men, 47 women; mean age 52 years; ranging between 36 and 66 years) with medial compartment osteoarthrosis were treated with proximal tibia medial open-wedge osteotomy. For fixation, plates which were designed by the first author and which support the osteotomy surface with wedge-shaped projections were used. The plates were either rectangular in shape with two or four holes or had an inverse "L" shape with four holes, and had bearing metal wedges of varying heights from 5 to 15 mm. Tricortical (n=8) and bicortical (n=43) iliac bone autografts and allografts (n=7) were used. The average follow-up time was 21 months (ranging between 6 and 44 months). The mean preoperative tibiofemoral angle was 4.6 degrees varus (0 degrees -11 degrees ) while it was 5.6 degrees valgus (2 degrees -11 degrees ) postoperatively. The mean preoperative HSS score was 58 (range 51-75) and it was found 89 (range 79-96) postoperatively. As complications, lateral tibial plateau fracture in 5 knees (8.6%) and lateral cortex fracture in 15 knees (25.8%) were encountered during surgery. Deep vein thrombosis in two cases (3.4%) and nonfatal pulmonary embolism in one case (1.7%), delayed wound healing in two knees (3.4%), and delayed union as well as breakdown of a distal screw in one knee (1.7%) were encountered postoperatively. In conclusion, using wedge plates for fixation of proximal tibia medial opening wedge osteotomy in the treatment of medial osteoarthritis with unicompartmental involvement of the knee, provides adequate stabilization to allow early movement for functional rehabilitation and keeps the obtained correction level.
在本研究中，我们评估了用于胫骨近端内侧开口楔形截骨固定的楔形钢板的适应证、手术技术及效果。连续56例患者（9例男性，47例女性；平均年龄52岁，范围36至66岁）共58膝，因内侧间室骨关节炎接受了胫骨近端内侧开放性楔形截骨治疗。固定采用由第一作者设计的、带有楔形突起以支撑截骨面的钢板。这些钢板呈矩形，有两孔或四孔，或呈倒“L”形且有四孔，带有高度从5至15毫米不等的承重金属楔块。使用了三皮质（n = 8）和双皮质（n = 43）的髂骨自体骨移植以及同种异体骨移植（n = 7）。平均随访时间为21个月（范围6至44个月）。术前平均胫股角为内翻4.6度（0度至 -11度），术后为外翻5.6度（2度至11度）。术前平均HSS评分为58分（范围51至75分），术后为89分（范围79至96分）。手术中出现5膝（8.6%）外侧胫骨平台骨折和15膝（25.8%）外侧皮质骨折作为并发症。术后出现2例（3.4%）深静脉血栓形成、1例（1.7%）非致命性肺栓塞、2膝（3.4%）伤口愈合延迟以及1膝（1.7%）出现延迟愈合和远端螺钉断裂。总之，使用楔形钢板固定胫骨近端内侧开口楔形截骨治疗膝关节单间室受累的内侧骨关节炎，可提供足够的稳定性，以允许早期活动进行功能康复并维持所获得的矫正程度。
