Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital Seongnam, Seongnam, South Korea.
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.
J Bone Joint Surg Am. 2021 Oct 6;103(19):1788-1797. doi: 10.2106/JBJS.20.00778.
Opening-wedge high tibial osteotomy produces opening gaps; however, there is little consensus on bone graft necessity and the material that would produce a superior union. The purposes of the present study were (1) to compare the serial union patterns associated with various bone-void fillers, (2) to determine whether bone-void filler is necessary to achieve bone union of the opening gap, and (3) to determine whether bone union is different according to the correction degree during opening-wedge high tibial osteotomy.
In this retrospective study, 97 knees were randomly assigned to treatment with hydroxyapatite chip bone (Group A), allogenic chip bone (Group B), or no bone graft (Group C) and were analyzed after a minimum 1-year follow-up. To compare the bone union pattern, the area of callus filling located at the most medial side on an anteroposterior radiograph of the knee was recorded, and a modified van Hemert scoring system was used in the mediolaterally divided 5 zones. The correlations between the correction degree and bone union scores were evaluated.
There were no significant differences in the extent of mediolateral bone-healing at 6 weeks or 3 months postoperatively (p = 0.172 and p = 0.228). However, Group C showed more prominent progression of the gap filling to the medial side compared with Groups A and B at 6 months postoperatively (p = 0.002). Group C showed slow progression of bone union up to 6 weeks but surpassed the other groups at 6 months. The union pattern was not different between Groups A and B, and the correction degree was not correlated with bone union beyond 3 months postoperatively.
Despite the different gap-healing patterns, opening-wedge high tibial osteotomy without bone graft achieved bone union comparable with allogenic and synthetic graft materials. Group C (no bone graft) showed slower progression of bone union but surpassed the other groups at around 6 months. Based on the union pattern, there was no difference depending on the correction degree and the use of bone-void fillers.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
楔形胫骨高位截骨术会产生开放间隙；然而，对于植骨的必要性以及哪种植骨材料更优，目前尚未达成共识。本研究的目的是：（1）比较各种骨缺损填充物的连续愈合模式；（2）确定是否需要骨缺损填充物来实现开放间隙的骨愈合；（3）确定在楔形胫骨高位截骨术中，根据矫正程度，骨愈合是否存在差异。
本回顾性研究将 97 例膝关节随机分为羟基磷灰石骨屑组（A 组）、同种异体骨屑组（B 组）和不植骨组（C 组），所有患者均随访至少 1 年。为了比较骨愈合模式，记录膝关节正位 X 线片上最内侧骨痂填充区域，并采用改良的 van Hemert 评分系统对 5 个内外侧分区进行评分。评估矫正程度与骨愈合评分之间的相关性。
术后 6 周和 3 个月时，各组间的骨愈合范围在统计学上无显著差异（p = 0.172 和 p = 0.228）。然而，术后 6 个月时，C 组较 A 组和 B 组的间隙填充向内侧进展更为明显（p = 0.002）。C 组的骨愈合进展缓慢，但在术后 6 个月时超过了其他两组。A 组和 B 组的愈合模式无差异，术后 3 个月后，矫正程度与骨愈合无相关性。
尽管骨愈合模式不同，但楔形胫骨高位截骨术不植骨也能达到与同种异体和合成植骨材料相当的骨愈合效果。C 组（不植骨）的骨愈合进展较慢，但在术后 6 个月左右超过了其他两组。根据愈合模式，在矫正程度和使用骨缺损填充物方面，无明显差异。
治疗性研究 III 级。欲了解完整的证据等级说明，请参阅作者须知。
