Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey.
Arthroscopy. 2018 Nov;34(11):3073-3079. doi: 10.1016/j.arthro.2018.06.041. Epub 2018 Oct 3.
To compare the accuracy of plain radiography and computed tomography (CT) in detecting lateral hinge fractures and to identify predictive factors of the lateral hinge fractures after open wedge high tibial osteotomy (HTO).
This study included patients who underwent isolated primary open wedge HTO for medial compartment degenerative arthritis from 2015 to 2016 and were evaluated by postoperative CT scans and followed for a minimum of 1 year. This study involved 48 patients (48 knees) undergoing open wedge HTO for primary medial osteoarthritis. Lateral hinge fractures were evaluated on immediate plain radiographs and CT scans according to the Takeuchi classification. Predictive factors of plain radiograph-based hinge fracture and CT-based hinge fracture were investigated.
The detection rate of lateral hinge fracture was significantly higher on CT scans than on plain radiographs (50% vs 14.6%; P < .001). Seven knees (14.6%) showed lateral hinge fractures on postoperative plain radiographs, including 6 with type I and 1 with type III fractures; 24 (50.0%) showed lateral hinge fractures on postoperative CT scans, including 20 with type I, 2 with type II, and 2 with type III fractures. CT scans detected 14 type I, 2 type II, and 1 type III hinge fractures not detected by plain radiographs. The medial opening gap width was the only predictor of lateral hinge fracture on CT scans (adjusted odds ratio, 1.565; P =.034).
The incidence of lateral hinge fracture of the knee after open wedge HTO was higher on CT scans than on plain radiographs. The medial opening gap width was the only predictor of lateral hinge fractures, suggesting a need for care when spreading the gap to avoid lateral hinge fractures.
Level III, cross-sectional study.
比较普通 X 线摄影和计算机断层扫描（CT）检测外侧铰链骨折的准确性，并确定开放式胫骨高位截骨术（HTO）后外侧铰链骨折的预测因素。
本研究纳入了 2015 年至 2016 年期间因内侧间室退行性关节炎行单纯初次开放式胫骨高位楔形截骨术的患者，术后均行 CT 扫描评估，并至少随访 1 年。本研究共纳入 48 例（48 膝）因原发性内侧骨关节炎行开放式胫骨高位楔形截骨术的患者。根据 Takeuchi 分类，在即刻普通 X 线片和 CT 扫描上评估外侧铰链骨折。研究了基于普通 X 线片的铰链骨折和基于 CT 的铰链骨折的预测因素。
CT 扫描检测外侧铰链骨折的检出率明显高于普通 X 线片（50%比 14.6%；P<.001）。术后普通 X 线片显示 7 膝（14.6%）出现外侧铰链骨折，其中 6 膝为 I 型骨折，1 膝为 III 型骨折；术后 CT 扫描显示 24 膝（50.0%）出现外侧铰链骨折，其中 20 膝为 I 型，2 膝为 II 型，2 膝为 III 型骨折。CT 扫描检测到 14 处普通 X 线片未检测到的 I 型、2 处 II 型和 1 处 III 型铰链骨折。CT 扫描上的内侧撑开间隙宽度是外侧铰链骨折的唯一预测因素（调整后的优势比，1.565；P=.034）。
开放式胫骨高位截骨术后 CT 扫描检测到的膝关节外侧铰链骨折发生率高于普通 X 线片。内侧撑开间隙宽度是外侧铰链骨折的唯一预测因素，这表明在撑开间隙时需要小心，以避免外侧铰链骨折。
III 级，横断面研究。
