Böhle Sabrina, Bischoff Lars, Ehrenmann Kristin, Layher Frank, Sander Klaus, Matziolis Georg, Pietsch Stefan
Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany.
Department of Surgery, Oberschwabenklinik, St. Elisabethen-Klinikum, 88212 Ravensburg, Germany.
Life (Basel). 2022 Aug 19;12(8):1265. doi: 10.3390/life12081265.
High tibial osteotomy (HTO) represents a sensible treatment option for patients with moderate unicondylar osteoarthritis of the knee and extraarticular malalignment. The possibility of a continuously variable correction setting and a surgical approach low in complications has meant that the medial opening osteotomy has prevailed over the past decades. The objective of the present study was to determine whether anteromedially positioned small plates are nevertheless forgiving under biomechanically unfavourable conditions (overcorrection and lateral hinge fracture). In this study, a simulated HTO was performed on composite tibiae with a 10-mm wedge and fixed-angle anteromedial osteosynthesis with a small implant. Force was applied axially in a neutral mechanical axis, a slight and a marked overcorrection into valgus, with and without a lateral hinge fracture in each case. At the same time, a physiological gait with a dual-peak force profile and a peak load of 2.4 kN was simulated. Interfragmentary motion and rigidity were determined. The rigidity of the osteosynthesis increased over the cycles investigated. A slight overcorrection into valgus led to the lowest interfragmentary motion, compared with pronounced valgisation and neutral alignment. A lateral hinge fracture led to a significant decrease in rigidity and increase in interfragmentary motion. However, in no case was the limit of 1 mm interfragmentary motion critical for osteotomy healing exceeded. The degree of correction of the leg axis, and the presence of a lateral hinge fracture, have an influence on rigidity and interfragmentary motion. From a mechanically neutral axis ranging up to pronounced overcorrection, the implant investigated offers sufficient stability to allow healing of the osteotomy, even if a lateral hinge fracture is present.
高位胫骨截骨术（HTO）是治疗中度膝关节单髁骨关节炎和关节外畸形患者的一种合理选择。连续可变的矫正设置以及并发症较少的手术方法，使得内侧开口截骨术在过去几十年中占据了主导地位。本研究的目的是确定在生物力学不利条件下（过度矫正和外侧铰链骨折），位于前内侧的小型钢板是否仍具有良好的耐受性。在本研究中，对带有10毫米楔形块的复合胫骨进行模拟HTO，并使用小型植入物进行固定角度的前内侧接骨术。在中立机械轴、轻度和明显外翻过度矫正的情况下轴向施加力，每种情况下均有或无外侧铰链骨折。同时，模拟具有双峰力分布和2.4 kN峰值负荷的生理步态。测定骨折块间的运动和刚度。在研究的周期内，接骨术的刚度增加。与明显外翻和中立对线相比，轻度外翻过度矫正导致骨折块间运动最低。外侧铰链骨折导致刚度显著降低和骨折块间运动增加。然而，在任何情况下，均未超过截骨愈合关键的1毫米骨折块间运动极限。下肢轴线的矫正程度以及外侧铰链骨折的存在，对刚度和骨折块间运动有影响。从机械中立轴到明显过度矫正，即使存在外侧铰链骨折，所研究的植入物也能提供足够的稳定性以允许截骨愈合。
