Liska Franz, Voss Andreas, Imhoff Florian B, Willinger Lukas, Imhoff Andreas B
Department of Sport Orthopaedics, Technische Universität München, Klinikum Rechts der Isar, Ismaninger Str. 22, D-81675, Munich, Germany.
Int Orthop. 2018 Jan;42(1):9-15. doi: 10.1007/s00264-017-3504-4. Epub 2017 May 23.
Due to a supposed high rate of nonunions in lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. The aim of this study was to report the occurrence of delayed- and nonunions following LOWDFO. We hypothesized that the occurrence of nonunions needing revision surgery is comparable to medial closing osteotomies.
Forty-one patients were treated with LOWDFO with a minimum follow-up of 12 months. Parameters such as age, gender, body mass index, valgus angle, the heights of the opening wedge, as well as the type of osteotomy (biplane vs single plane) were collected. Delayed union and nonunion were evaluated on radiographs along with clinical symptoms.
The study group consisted of 21 females and 20 males, with a median age of 37 years at the time of surgery. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). The median preoperative valgus angle was 6.1° valgus (range 2-15.5°). The heights of the opening wedge ranged from 2 to 12 mm (mean 5.3 mm). Hinge fracture of the medial cortex was seen in 39%. Three patients had a delayed union, and one patient had a nonunion requiring revision surgery.
LOWDFO is a safe alternative to MCWDFO. Although radiolucency of the osteotomy gap can be evident on radiographs even after 12 months, this does not reflect the clinical finding. The nonunion rate is proven to be low and comparable with the nonunion rates of MCWDFOs as well as open wedge HTOs.
由于外侧开放楔形股骨远端截骨术（LOWDFO）中骨不连发生率较高，内侧闭合楔形技术长期以来更受青睐。本研究旨在报告LOWDFO术后延迟愈合和骨不连的发生情况。我们假设需要翻修手术的骨不连发生率与内侧闭合截骨术相当。
41例患者接受了LOWDFO治疗，最短随访时间为12个月。收集了年龄、性别、体重指数、外翻角度、开放楔形高度以及截骨类型（双平面与单平面）等参数。通过X线片及临床症状评估延迟愈合和骨不连情况。
研究组包括21名女性和20名男性，手术时的中位年龄为37岁。1.3年（0.6 - 2.1年）后，63%的患者取出了内固定物。术前中位外翻角度为6.1°外翻（范围2 - 15.5°）。开放楔形高度范围为2至12毫米（平均5.3毫米）。39%的患者出现内侧皮质铰链骨折。3例患者发生延迟愈合，1例患者发生骨不连需要翻修手术。
LOWDFO是MCWDFO的一种安全替代方法。尽管即使在12个月后，截骨间隙的透亮区在X线片上仍可能很明显，但这并不反映临床情况。事实证明，骨不连发生率较低，与MCWDFO以及开放楔形高位胫骨截骨术的骨不连发生率相当。
