后结核性间隙增宽可由不适当的前侧骨切开术和内侧双平面开放式楔形 HT O 中的大开口间隙引起。
Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap in the medial biplanar open-wedge HTO.
机构信息
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Sep;27(9):2910-2916. doi: 10.1007/s00167-018-4991-6. Epub 2018 May 26.
PURPOSE
The purpose of this study was to investigate the causes of retro-tubercular gap widening and to confirm whether this widened gap causes instability of the osteotomy configuration during open-wedge high tibial osteotomy (OWHTO).
METHODS
Operative records and radiologic findings of patients who underwent biplanar medial OWHTO between 2014 and 2016 were retrospectively evaluated. To identify the osteotomy configuration including lateral hinge fracture, postoperative simple radiographs and CT images were analyzed. Postoperative CT scan was used to evaluate the widening of the retro-tubercular gap, thickness, and axial angle of retro-tubercular osteotomy, as well as the ratios of anterior and posterior osteotomy, and hinge length. The correlation of each factor was evaluated and analyzed in accordance with the lateral hinge fracture (LHF).
RESULTS
Widening of the retro-tubercular gap showed a significant correlation with the axial angle of retro-tubercular osteotomy, anterior osteotomy ratio, and opening gap distance, but not with the thickness of retro-tubercular osteotomy, posterior osteotomy ratio, and hinge length ratio. The LHF group showed significantly larger value than the non-LHF group with respect to the thickness of retro-tubercular osteotomy (P = 0.003), axial angle of retro-tubercular osteotomy (P = 0.033), retro-planar gap distance (P = 0.001), anterior osteotomy ratio (P = 0.000), and opening gap distance (P = 0.003). The hinge length ratio was smaller in the LHF group than in the non-LHF group (P = 0.001). However, the posterior osteotomy ratio was not different between the two groups (n.s.).
CONCLUSION
Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap distance, which can be related to LHF. Therefore, anterior cortical osteotomy may also be an important factor for preventing instability of the proximal fragment in biplanar OWHTO.
LEVEL OF EVIDENCE
Case-control study, Level III.
目的
本研究旨在探讨导致胫骨高位截骨术后（HTO）骨间后间隙增宽的原因，并确认这种增宽的间隙是否会导致开放性楔形胫骨高位截骨术（OWHTO）中截骨位置的不稳定。
方法
回顾性分析了 2014 年至 2016 年期间接受双平面内侧 OWHTO 的患者的手术记录和影像学结果。为了确定包括外侧铰链骨折在内的截骨形态，对术后的简单 X 线片和 CT 图像进行了分析。术后 CT 扫描用于评估骨间后间隙的增宽、厚度、骨间后截骨的轴向角度以及前、后截骨的比例和铰链长度。根据外侧铰链骨折（LHF）评估了各因素之间的相关性。
结果
骨间后间隙的增宽与骨间后截骨的轴向角度、前截骨比例和开口间隙距离显著相关，但与骨间后截骨的厚度、后截骨比例和铰链长度比例无关。LHF 组在骨间后截骨厚度（P = 0.003）、骨间后截骨轴向角度（P = 0.033）、后平面间隙距离（P = 0.001）、前截骨比例（P = 0.000）和开口间隙距离（P = 0.003）方面的测量值明显大于非 LHF 组。LHF 组的铰链长度比例明显小于非 LHF 组（P = 0.001）。然而，两组间的后截骨比例没有差异（n.s.）。
结论
骨间后间隙增宽可由不当的前侧皮质骨截骨和较大的开口间隙距离引起，这可能与 LHF 有关。因此，前侧皮质骨截骨可能也是防止双平面 OWHTO 中近端骨块不稳定的一个重要因素。
证据等级
病例对照研究，III 级。
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