Department of Orthopaedic Surgery, Yokohama City University, School of Medicine, Yokohama, Japan.
Arthroscopy. 2012 Jan;28(1):85-94. doi: 10.1016/j.arthro.2011.06.034. Epub 2011 Oct 7.
The purpose of this study was to determine the frequency of lateral hinge fractures after opening-wedge high tibial osteotomy and investigate the patterns of fracture and their clinical outcome.
We analyzed 104 knees in 93 patients with a mean age of 68 ± 7 years. Of the knees, 74 were diagnosed as having primary osteoarthritis and 30 with osteonecrosis. The mean follow-up period was 41 months. Lateral hinge fractures were classified as follows: type I, the fracture reaches just proximal to or within the tibiofibular joint; type II, the fracture reaches the distal portion of the proximal tibiofibular joint; and type III, a lateral plateau fracture. A standard postoperative rehabilitation protocol was used for type I fractures, 3 of 5 patients with type II fractures were treated with non-weight bearing, and type III fractures were treated with non-weight bearing until visible callus formation.
The Knee Society scores for the knee and for function showed improvement from 49 ± 11 to 91 ± 7.7 points and from 62 ± 13 to 95 ± 8.2 points, respectively. Lateral cortex fractures were observed in 26 knees (25%): 19 type I, 5 type II, and 2 type III. In the type II fracture group, 2 of 5 patients were judged to have a delayed bone union. There were 2 cases of infection (2%) and 1 case of traumatic neuroma (1%) but no instances of implant failure, nonunion, or deep vein thrombosis among our patient cohort.
High tibial osteotomy patients treated with a combination of TomoFix (Synthes, Bettlach, Switzerland) and bone substitute were able to walk with full weight bearing 2 weeks after surgery. No complications were seen in 19 patients with type I fractures. Of 5 patients with type II fractures, 2 had delayed unions with a correction loss of 3° and 7°, respectively.
Level IV, therapeutic case series.
本研究旨在确定外侧铰链骨折在开放式楔形胫骨高位截骨术后的发生频率，并探讨骨折类型及其临床结果。
我们分析了 93 名患者的 104 膝，平均年龄 68±7 岁。其中 74 例诊断为原发性骨关节炎，30 例诊断为股骨头坏死。平均随访时间为 41 个月。外侧铰链骨折分为以下几类：I 型，骨折仅达胫腓骨关节近端或其内；II 型，骨折达胫腓骨近端关节的远端部分；III 型，外侧平台骨折。对于 I 型骨折，采用标准的术后康复方案；5 例 II 型骨折中的 3 例采用非负重治疗；III 型骨折采用非负重治疗，直至可见骨痂形成。
膝关节和功能的膝关节协会评分分别从 49±11 分提高到 91±7.7 分和从 62±13 分提高到 95±8.2 分。26 膝（25%）出现外侧皮质骨折：19 例为 I 型，5 例为 II 型，2 例为 III 型。在 II 型骨折组中，5 例中有 2 例出现延迟愈合。我们的患者队列中没有感染（2%）、创伤性神经瘤（1%）或植入物失败、骨不连或深静脉血栓形成的病例。
采用 TomoFix（瑞士 Bettlach 的 Synthes）和骨替代物治疗的胫骨高位截骨术患者术后 2 周即可完全负重行走。19 例 I 型骨折患者无并发症。5 例 II 型骨折患者中，2 例出现延迟愈合，分别有 3°和 7°的矫正丢失。
IV 级，治疗性病例系列研究。
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