Nha Kyung-Wook, Chang Yong Suk, Shon Oog-Jin, Shim Bum-Jin, Lee Jong Seong, Song Jun Seop, Bae Ji-Hoon
Department of Orthopaedic Surgery, IIsan Paik Hospital, Inje University, Goyang, Republic of Korea.
Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea.
J Knee Surg. 2019 Mar;32(3):274-279. doi: 10.1055/s-0038-1641144. Epub 2018 Apr 4.
The purpose of this study was to investigate whether the location of the hinge affects the incidence of hinge fracture during medial closing-wedge distal femoral varus osteotomy (DFVO). Twenty knees from 10 fresh-frozen human cadavers (mean age, 75 ± 17 years) were used to perform uniplanar medial closing-wedge DFVO with a 7-mm wedge. Each specimen was randomly assigned to either group A (supracondylar hinge) or group B (lateral condylar hinge). The incidence of hinge fracture and stability was compared between both groups after uniplanar medial closing-wedge DFVO. In group A, 8 of 10 knees had a lateral cortex fracture during closure of the osteotomy gap, and all fractured knees were unstable. Two knees with an intact lateral cortical hinge showed stability under manual valgus and varus forces. After intentional breakage of the lateral cortical hinge, both knees were found to be unstable under the same force. In group B, 2 of 10 knees had a lateral cortex fracture, and 8 knees had no fractures. All specimens were found to be stable under manual valgus and varus forces. After intentional breakage of the lateral cortical hinge in group B, 2 knees were unstable, while 8 knees remained stable. This study showed a significantly higher incidence of lateral cortical hinge fracture and instability in group A than in group B during closure of the osteotomy gap.
本研究的目的是调查在股骨远端内翻闭合楔形截骨术（DFVO）中铰链的位置是否会影响铰链骨折的发生率。使用来自10具新鲜冷冻人体尸体（平均年龄75±17岁）的20个膝关节进行单平面内侧闭合楔形DFVO，截骨厚度为7毫米。每个标本随机分为A组（髁上铰链）或B组（外侧髁铰链）。比较单平面内侧闭合楔形DFVO后两组铰链骨折的发生率和稳定性。在A组中，10个膝关节中有8个在截骨间隙闭合时出现外侧皮质骨折，所有骨折的膝关节均不稳定。两个外侧皮质铰链完整的膝关节在手动外翻和内翻力作用下表现出稳定性。在故意破坏外侧皮质铰链后，发现这两个膝关节在相同力作用下均不稳定。在B组中，10个膝关节中有2个出现外侧皮质骨折，8个膝关节未发生骨折。所有标本在手动外翻和内翻力作用下均表现出稳定性。在故意破坏B组的外侧皮质铰链后，2个膝关节不稳定，而8个膝关节仍保持稳定。本研究表明，在截骨间隙闭合期间，A组外侧皮质铰链骨折和不稳定的发生率明显高于B组。
