Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Department of Orthopaedic Surgery, Meiwa Hospital, Nishinomiya, Japan.
Arch Orthop Trauma Surg. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. Epub 2022 Jun 8.
To compare bone union after medial closing wedge distal femoral osteotomy (MCWDFO) with that after lateral closing wedge distal femoral osteotomy (LCWDFO) using a novel scoring system.
The data of 30 patients who received biplanar MCWDFO for valgus knees (MCWDFO group) were retrospectively examined and compared to that of 22 patients (25 knees) who underwent biplanar LCWDFO via a double-level osteotomy (DLO) for varus knees (LCWDFO group). The progression of bone union of the transverse osteotomy plane in the femur was assessed using a newly developed scoring system using radiographs taken immediately after surgery and 3 and 6 months postoperatively. The scoring system is based on a scale of zero to six points with higher scores indicating better bone union. The incidence of hinge fractures was assessed using CT images, and the rates of reoperation were evaluated using medical record data.
The mean bone union score was significantly lower in the MCWDFO group than in the LCWDFO group 3 months (2.1 ± 1.9 vs. 3.7 ± 1.7, P < 0.01) and 6 months (3.8 ± 2.1 vs 4.9 ± 1.5, P < 0.05) postoperatively. The incidence ratio of hinge fractures was significantly higher in the MCWDFO group than in the LCWDFO group (70.0% vs. 32.0%, P < 0.01). Two patients in the MCWDFO group underwent reoperation for delayed bone union or non-union.
Bone union progression was slower and hinge fractures were more frequently observed after MCWDFO than after LCWDFO via DLO. MCWDFO is technically challenging, and patients must be monitored closely during and after surgery.
使用新的评分系统比较内侧闭合楔形股骨远端截骨术（MCWDFO）和外侧闭合楔形股骨远端截骨术（LCWDFO）后的骨愈合情况。
回顾性分析了 30 例接受双平面 MCWDFO 治疗外翻膝（MCWDFO 组）的患者的资料，并与 22 例（25 膝）接受双平面 LCWDFO 经双水平截骨术（DLO）治疗内翻膝（LCWDFO 组）的患者进行比较。使用新开发的评分系统，根据术后即刻、术后 3 个月和 6 个月拍摄的 X 线片评估股骨横向截骨平面的骨愈合进展情况。评分系统基于 0 至 6 分的评分，得分越高表示骨愈合越好。使用 CT 图像评估铰链骨折的发生率，使用病历数据评估再次手术率。
MCWDFO 组术后 3 个月（2.1±1.9 比 3.7±1.7，P<0.01）和 6 个月（3.8±2.1 比 4.9±1.5，P<0.05）时骨愈合评分明显低于 LCWDFO 组。MCWDFO 组铰链骨折发生率明显高于 LCWDFO 组（70.0%比 32.0%，P<0.01）。MCWDFO 组有 2 例患者因延迟骨愈合或不愈合而再次手术。
与经 DLO 的 LCWDFO 相比，MCWDFO 后骨愈合进展较慢，铰链骨折更常见。MCWDFO 技术难度较大，术后必须密切监测患者。
