Nakamura R, Komatsu N, Fujita K, Kuroda K, Takahashi M, Omi R, Katsuki Y, Tsuchiya H
Harue Hospital, 65-7 Harue-cho Haribara, Sakai, Japan.
Yawata Medical Center, Komatsu, Japan.
Bone Joint J. 2017 Oct;99-B(10):1313-1318. doi: 10.1302/0301-620X.99B10.BJJ-2017-0103.R1.
Open wedge high tibial osteotomy (OWHTO) for medial-compartment osteoarthritis of the knee can be complicated by intra-operative lateral hinge fracture (LHF). We aimed to establish the relationship between hinge position and fracture types, and suggest an appropriate hinge position to reduce the risk of this complication.
Consecutive patients undergoing OWHTO were evaluated on coronal multiplanar reconstruction CT images. Hinge positions were divided into five zones in our new classification, by their relationship to the proximal tibiofibular joint (PTFJ). Fractures were classified into types I, II, and III according to the Takeuchi classification.
Among 111 patients undergoing OWHTOs, 22 sustained lateral hinge fractures. Of the 89 patients without fractures, 70 had hinges in the zone within the PTFJ and lateral to the medial margin of the PTFJ (zone WL), just above the PTFJ. Among the five zones, the relative risk of unstable fracture was significantly lower in zone WL (relative risk 0.24, confidence interval 0.17 to 0.34).
Zone WL appears to offer the safest position for the placement of the osteotomy hinge when trying to avoid a fracture at the osteotomy site. Cite this article: 2017;99B10:1313-18.
膝关节内侧间室骨关节炎的开放性楔形高位胫骨截骨术（OWHTO）可能会并发术中外侧铰链骨折（LHF）。我们旨在确定铰链位置与骨折类型之间的关系，并提出合适的铰链位置以降低这种并发症的风险。
对接受OWHTO的连续患者进行冠状面多平面重建CT图像评估。根据铰链位置与近端胫腓关节（PTFJ）的关系，在我们新的分类中将铰链位置分为五个区域。根据竹内分类法将骨折分为I型、II型和III型。
在111例行OWHTO的患者中，22例发生外侧铰链骨折。在89例未发生骨折的患者中，70例的铰链位于PTFJ内且在PTFJ内侧边缘外侧的区域（WL区），即PTFJ上方。在这五个区域中，WL区不稳定骨折的相对风险显著较低（相对风险0.24，置信区间0.17至0.34）。
在试图避免截骨部位骨折时，WL区似乎为截骨铰链的放置提供了最安全的位置。引用本文：2017;99B10:1313 - 18。
