Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Knee Surg Sports Traumatol Arthrosc. 2021 Oct;29(10):3450-3457. doi: 10.1007/s00167-020-06296-8. Epub 2020 Sep 28.
The purpose of this study was to evaluate the area of the osteotomy surface, including the flange and wedge volume, in open wedge high tibial osteotomy (OWHTO), distal tibial tuberosity osteotomy (DTO), and distal tibial tuberosity arc osteotomy (DTAO) using tibial sawbones. It was hypothesized that the area of the osteotomy surface, including the flange, in DTAO was larger than that in OWHTO and DTO and that the wedge volume in DTAO was smaller than that in OWHTO and DTO.
Fifteen tibial sawbones were divided equally into three groups: OWHTO, DTO, and DTAO. The total area of the osteotomy surface in OWHTO, DTO, and DTAO was compared using image analysis software. The contact area of the flange and the wedge volume at wedge heights of 5, 10, and 15 mm were compared among osteotomy types. One-way repeated-measures analysis of variance was used to compare the total area of the osteotomy surface, the contact area of the flange, and the wedge volume at 5, 10, and 15 mm in OWHTO, DTO, and DTAO.
The total area of the osteotomy surface in DTO and DTAO was significantly larger than that in OWHTO (P < 0.05). The contact area of the flange in DTAO was significantly larger than that in OWHTO at each wedge height (P < 0.05). In addition, the contact area of the flange in DTAO was significantly larger than that in DTO at wedge heights of 5 and 15 mm (P < 0.05). The wedge volume in DTAO was significantly smaller than that in DTO at each wedge height (P < 0.05).
This study demonstrated that an increase in the flange contact area and a decrease in the wedge volume in the opening gap were found in DTAO compared to DTO. This would be an advantage for anteroposterior screw insertion from the flange to the distal tibial fragment and bone union at the osteotomy site.
本研究旨在通过胫骨标本评估开放式楔形胫骨高位截骨术（OWHTO）、胫骨结节切开术（DTO）和胫骨结节弧形截骨术（DTAO）的截骨面面积，包括翼缘和楔形体积。假设 DTAO 的截骨面面积（包括翼缘）大于 OWHTO 和 DTO，DTAO 的楔形体积小于 OWHTO 和 DTO。
将 15 个胫骨标本平均分为 3 组：OWHTO、DTO 和 DTAO。使用图像分析软件比较 OWHTO、DTO 和 DTAO 的截骨面总面积。比较不同截骨类型在楔形高度为 5、10 和 15mm 时翼缘的接触面积和楔形体积。采用单因素重复测量方差分析比较 OWHTO、DTO 和 DTAO 截骨面总面积、翼缘接触面积和楔形体积在 5、10 和 15mm 时的差异。
DTO 和 DTAO 的截骨面总面积明显大于 OWHTO（P<0.05）。DTAO 的翼缘接触面积在每个楔形高度均明显大于 OWHTO（P<0.05）。此外，DTAO 的翼缘接触面积在楔形高度为 5 和 15mm 时明显大于 DTO（P<0.05）。DTAO 的楔形体积在每个楔形高度均明显小于 DTO（P<0.05）。
与 DTO 相比，DTAO 中翼缘接触面积增加，开口间隙楔形体积减小。这有利于从翼缘向胫骨远端骨块插入前后螺钉和骨在截骨部位愈合。
