Song Ju-Ho, Bin Seong-Il, Kim Jong-Min, Lee Bum-Sik, Park Jun-Gu, Lee Sang-Min
Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Orthop J Sports Med. 2022 Nov 15;10(11):23259671221137042. doi: 10.1177/23259671221137042. eCollection 2022 Nov.
Whether lateral hinge fracture (LHF) after open-wedge high tibial osteotomy (OWHTO) is associated with the change in tibial posterior slope (PS) has not been determined. Risk factors for PS increase are still unknown.
There will be no difference in patient characteristics and radiographic factors when stratified by change in tibial PS (ΔPS).
Cohort study; Level of evidence, 3.
We reviewed the records of 148 patients who underwent OWHTO with locking-plate fixation from 2010 to 2016. Included were those with a minimum 2-year follow-up and true lateral radiographs before and at 1 year after surgery. ΔPS was defined as a difference between preoperative and 1-year postoperative PS, with positive values indicating PS increase. ΔPS was classified into <3°, 3° to <6°, and ≥6°. Any LHFs were grouped by Takeuchi classification as stable (type 1) or unstable (types 2 and 3). Risk factors for PS increase were evaluated using ordinal logistic regression analyses. Clinical outcomes according to ΔPS were evaluated using the Hospital for Special Surgery score.
There were 79 (53.4%) patients with ΔPS <3°, 44 (29.7%) with 3° ≤ ΔPS < 6°, and 25 (16.9%) with ΔPS ≥6°. LHFs were observed in 41 (27.7%) patients: 32 with type 1 and 7 and 2 with types 2 and 3, respectively. Results of the multivariate ordinal logistic regression analysis indicated that ΔPS was associated with unstable LHF ( = .005, exp[β] = 6.34), preoperative PS ( = .028, exp[β] = 0.90), and correction angle ( = .037, exp[β] = 1.09). ΔPS ≥6° was seen in 4 of 9 (44.4%) patients with unstable LHF, 9 of 32 (28.1%) with stable LHF, and 12 of 107 (11.2%) with no LHF ( = .017). The mean correction angle was 11.3° ± 3.6° in patients with ΔPS ≥6°, 9.4° ± 4.6° in cases of 3° ≤ ΔPS < 6°, and 8.8° ± 3.6° in cases of ΔPS <3° ( = .019). Hospital for Special Surgery scores did not differ according to ΔPS.
LHF type and correction angle were associated with ΔPS after OWHTO, and unstable LHF and large correction angle were risk factors for PS increase. There was no significant difference in clinical outcomes according to ΔPS.
开放性楔形高位胫骨截骨术（OWHTO）后外侧铰链骨折（LHF）是否与胫骨后倾坡度（PS）的改变相关尚未明确。PS增加的危险因素仍不清楚。
根据胫骨PS的变化（ΔPS）进行分层时，患者特征和影像学因素不会存在差异。
队列研究；证据等级，3级。
我们回顾了2010年至2016年期间接受OWHTO并使用锁定钢板固定的148例患者的记录。纳入对象为至少随访2年且有术前及术后1年真实侧位X线片的患者。ΔPS定义为术前与术后1年PS的差值，正值表示PS增加。ΔPS分为<3°、3°至<6°和≥6°。所有LHF根据竹内分类法分为稳定型（1型）或不稳定型（2型和3型）。使用有序逻辑回归分析评估PS增加的危险因素。根据ΔPS评估临床结局，采用特种外科医院评分。
ΔPS<3°的患者有79例（53.4%），3°≤ΔPS<6°的患者有44例（29.7%），ΔPS≥6°的患者有25例（16.9%）。41例（27.7%）患者观察到LHF：32例为1型，7例为2型，2例为3型。多变量有序逻辑回归分析结果表明，ΔPS与不稳定LHF相关（P=.005，exp[β]=6.34）、术前PS相关（P=.028，exp[β]=0.90）以及矫正角度相关（P=.037，exp[β]=1.09）。9例不稳定LHF患者中有4例（44.4%）出现ΔPS≥6°，32例稳定LHF患者中有9例（28.1%）出现，107例无LHF患者中有12例（11.2%）出现（P=.017）。ΔPS≥6°的患者平均矫正角度为11.3°±3.6°，3°≤ΔPS<6°的患者为9.4°±4.6°，ΔPS<3°的患者为8.8°±3.6°（P=.019）。特种外科医院评分根据ΔPS无差异。
OWHTO后LHF类型和矫正角度与ΔPS相关，不稳定LHF和大矫正角度是PS增加的危险因素。根据ΔPS，临床结局无显著差异。
