Schröter Steffen, Freude Thomas, Kopp Marcel Matthias, Konstantinidis Lukas, Döbele Stefan, Stöckle Ulrich, van Heerwaarden Ronald
BG Trauma Center Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, Tübingen, Germany.
BG Trauma Center Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, Tübingen, Germany.
Arthroscopy. 2015 Feb;31(2):254-65. doi: 10.1016/j.arthro.2014.08.028. Epub 2014 Oct 23.
The purpose of this study was to examine the osteotomy gap filling rate with new bone after open wedge high tibial osteotomy (HTO) without bone graft and the effects of smoking, lateral hinge fracture, and early full weight bearing.
A prospective series (N = 70) of open wedge HTOs with the TomoFix plate (DePuy Synthes, Umkirch, Germany) was performed. Radiologic follow-up examinations took place postoperatively, after 6 and 12 weeks, and after 6, 12, and 18 months to measure osteotomy gap filling at each follow-up. Bone healing was compared in smokers versus nonsmokers who underwent open wedge HTOs with intact lateral hinges. Fractured lateral hinges were classified according to the Takeuchi classification and separately analyzed regarding bone healing. Patients were randomly assigned to undergo early (11 days) or standard (6 weeks) full-weight-bearing rehabilitation.
A delay in the osteotomy gap filling rate between smokers and nonsmokers could be observed at all follow-up periods, but differences were not significant. A fracture of the lateral hinge was found in 39% of the patients. A type I fracture was observed in 14% of patients, a type II fracture was observed in 13%, and a type III fracture was found in 6%. The highest increase in the osteotomy gap filling rate was observed between 12 weeks and 6 months after surgery in patients with intact lateral hinges. For patients with unstable type II fractures, the highest increase in the gap filling rate was delayed until 6 to 12 months. Early full weight bearing had no effect on the gap filling rate in any of the patient groups evaluated.
This study shows that osteotomy gap filling after open wedge HTO is delayed in smokers and in patients in whom opening of the gap resulted in unstable lateral hinge fractures. Early full weight bearing did not have a significant effect on the gap filling rate.
Level III, prognostic study.
本研究旨在探讨采用无植骨的开放楔形高位胫骨截骨术（HTO）后，截骨间隙的新骨填充率，以及吸烟、外侧铰链骨折和早期完全负重的影响。
采用TomoFix钢板（德国迪普伊辛迪斯公司，乌姆基希）对70例患者进行前瞻性开放楔形HTO系列手术。术后、6周和12周以及6、12和18个月后进行影像学随访检查，以测量每次随访时的截骨间隙填充情况。比较接受开放楔形HTO且外侧铰链完整的吸烟者和非吸烟者的骨愈合情况。根据竹内分类法对骨折的外侧铰链进行分类，并分别分析其骨愈合情况。患者被随机分配接受早期（11天）或标准（6周）完全负重康复治疗。
在所有随访期均观察到吸烟者和非吸烟者之间截骨间隙填充率存在延迟，但差异无统计学意义。39%的患者出现外侧铰链骨折。14%的患者观察到I型骨折，13%观察到II型骨折，6%观察到III型骨折。外侧铰链完整的患者在术后12周和6个月之间截骨间隙填充率的增幅最大。对于不稳定的II型骨折患者，间隙填充率的最大增幅延迟至6至12个月。早期完全负重对任何评估的患者组的间隙填充率均无影响。
本研究表明，开放楔形HTO术后，吸烟者以及截骨间隙开放导致外侧铰链骨折不稳定的患者，截骨间隙的填充会延迟。早期完全负重对间隙填充率无显著影响。
III级，预后研究。
Zotero 插件