不稳定外侧铰链骨折或隐匿性完全截骨术会对开放式楔形胫骨高位截骨术的矫正准确性产生不利影响。
Unstable Lateral Hinge Fracture or Occult Complete Osteotomy Adversely Affects Correction Accuracy in Open-Wedge High Tibial Osteotomy.
机构信息
Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
Arthroscopy. 2021 Nov;37(11):3297-3306. doi: 10.1016/j.arthro.2021.04.032. Epub 2021 Apr 30.
PURPOSE
To verify whether lateral hinge fracture (LHF) affects correction accuracy in open-wedge high tibial osteotomy (OWHTO) and to identify the fracture characteristics responsible for inaccurate correction, including LHF type and hinge location.
METHODS
Patients undergoing OWHTO with locking plate fixation between 2010 and 2016 were retrospectively reviewed. Patients who did not have a minimum 2-year of follow-up or postoperative long-standing hip-to-ankle radiographs were excluded. Correction accuracy was assessed using the weight-bearing line ratio: 57% to 67%, planned correction; 50% to 70%, acceptable correction; otherwise, inappropriate correction. The association between LHF and correction accuracy was assessed using the χ test. To identify the fracture characteristics responsible for inaccurate correction, LHF type (stable type 1 and unstable types 2 and 3) and hinge location (shallow osteotomy, deep osteotomy, and occult complete osteotomy) were analyzed using ordinal logistic regression analysis, taking other related demographic and radiologic factors into account. Clinical outcomes according to LHF type were evaluated using the Hospital for Special Surgery scores.
RESULTS
A total of 148 cases were included; 41 (27.7%) showed LHF: type 1, 32 cases; type 2, 7 cases; and type 3, 2 cases. Planned, acceptable, and inappropriate corrections were noted in 63 (42.6%), 36 (24.3%), and 48 (32.4%) cases, respectively. LHF had a significant association with correction accuracy (P = .010). Regarding fracture characteristics, unstable LHF and occult complete osteotomy were significant risk factors (P = .016 and P = .004, respectively). Specifically in cases of stable LHF, occult complete osteotomy adversely affected correction accuracy (P = .025). No difference was found in the final Hospital for Special Surgery scores according to LHF type (P = .816).
CONCLUSIONS
LHF affected the accuracy of coronal alignment correction in OWHTO. Unstable LHF or occult complete osteotomy were risk factors for inaccurate correction. Even among stable LHFs, those with occult complete osteotomy could lead to inaccurate correction.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
目的
验证外侧铰链骨折（LHF）是否会影响开放式楔形胫骨高位截骨术（OWHTO）中的矫正准确性，并确定导致矫正不准确的骨折特征，包括 LHF 类型和铰链位置。
方法
回顾性分析 2010 年至 2016 年间接受锁定钢板固定的 OWHTO 患者。排除随访时间不足 2 年或术后存在长时间的髋踝正位片的患者。采用负重线比值评估矫正准确性：57%至 67%，为计划矫正；50%至 70%，为可接受矫正；否则，为不适当矫正。采用 χ²检验评估 LHF 与矫正准确性之间的关系。为确定导致矫正不准确的骨折特征，采用有序逻辑回归分析 LHF 类型（稳定型 1 型和不稳定型 2 型和 3 型）和铰链位置（浅骨切开、深骨切开和隐匿性完全骨切开），同时考虑其他相关的人口统计学和影像学因素。根据 LHF 类型评估临床结果采用特殊外科医院评分。
结果
共纳入 148 例患者，其中 41 例（27.7%）出现 LHF：1 型 32 例，2 型 7 例，3 型 2 例。分别有 63 例（42.6%）、36 例（24.3%）和 48 例（32.4%）患者获得了计划矫正、可接受矫正和不适当矫正。LHF 与矫正准确性显著相关（P=.010）。在骨折特征方面，不稳定型 LHF 和隐匿性完全骨切开是显著的危险因素（P=.016 和 P=.004）。具体而言，在稳定型 LHF 中，隐匿性完全骨切开会对矫正准确性产生不利影响（P=.025）。根据 LHF 类型，最终特殊外科医院评分无差异（P=.816）。
结论
LHF 影响 OWHTO 中冠状面对线矫正的准确性。不稳定型 LHF 或隐匿性完全骨切开是矫正不准确的危险因素。即使在稳定型 LHF 中，存在隐匿性完全骨切开也可能导致矫正不准确。
证据水平
III 级，回顾性队列研究。
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