Fujii Yuta, Nakagawa Shuji, Arai Yuji, Inoue Atsuo, Kaihara Kenta, Takahashi Kenji
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto 602-8566, Japan.
Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto 602-8566, Japan.
Knee. 2022 Dec;39:10-17. doi: 10.1016/j.knee.2022.08.003. Epub 2022 Sep 14.
One of the complications of open wedge high tibial osteotomy is lateral hinge fracture, which causes delayed bone healing. In this study, we focused on the morphology of the proximal tibiofibular joint to clarify the influence of this morphology on the occurrence of lateral hinge fracture in open wedge high tibial osteotomy.
The proximal tibiofibular joint of 58 knees in 55 patients who underwent open wedge high tibial osteotomy was classified as either horizontal or oblique, depending on the morphology of the fibular head. Lateral hinge fracture of Takeuchi classification type II or III was defined as unstable lateral hinge fracture. We analyzed whether patient background and bone morphological factors, including the morphology of the proximal tibiofibular joint, were associated with the occurrence of unstable lateral hinge fracture.
The horizontal and oblique types were found in 34 and 24 knees, respectively. There was no difference in the percentage of hinge points within the safe zone between the horizontal and oblique types; however, there was a significant difference in the unstable lateral hinge fracture incidence between the two groups. Unstable lateral hinge fracture occurred in seven knees, mostly in patients with an oblique proximal tibiofibular joint. The factors associated with the occurrence of unstable lateral hinge fracture were analyzed using logistic regression analysis; the fibular head of the oblique type was a significant factor.
Open wedge high tibial osteotomy for oblique-type proximal tibiofibular joints may be more likely to cause unstable lateral hinge fracture than the horizontal type.
开放性楔形高位胫骨截骨术的并发症之一是外侧铰链骨折，这会导致骨愈合延迟。在本研究中，我们聚焦于胫腓近端关节的形态，以阐明这种形态对开放性楔形高位胫骨截骨术中外侧铰链骨折发生的影响。
根据腓骨头的形态，将55例行开放性楔形高位胫骨截骨术患者的58个膝关节的胫腓近端关节分为水平型或斜型。竹内分类II型或III型的外侧铰链骨折被定义为不稳定外侧铰链骨折。我们分析了患者背景和骨形态学因素，包括胫腓近端关节的形态，是否与不稳定外侧铰链骨折的发生有关。
分别在34个和24个膝关节中发现水平型和斜型。水平型和斜型在安全区内铰链点的百分比没有差异；然而，两组之间不稳定外侧铰链骨折的发生率有显著差异。不稳定外侧铰链骨折发生在7个膝关节中，大多发生在胫腓近端关节为斜型的患者中。使用逻辑回归分析来分析与不稳定外侧铰链骨折发生相关的因素；斜型的腓骨头是一个显著因素。
与水平型相比，对斜型胫腓近端关节行开放性楔形高位胫骨截骨术可能更易导致不稳定外侧铰链骨折。
