Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea.
Knee Surg Sports Traumatol Arthrosc. 2023 Sep;31(9):3956-3963. doi: 10.1007/s00167-023-07427-7. Epub 2023 Apr 26.
To compare the changes in posterior tibial slope (PTS) between retrotuberosity biplane open-wedge high tibial osteotomies (RT-OWHTOs) with and without additional anteromedial staple fixation.
Seventy-nine and 77 cases of RT-OWHTOs without (Group N) and with (Group S) additional staple fixation, respectively, were retrospectively reviewed. All procedures were performed using a locking spacer plate. Demographics and preoperative knee condition were similar between the groups. Clinically, the Western Ontario and McMaster Universities Arthritis Index and range of motion were evaluated preoperatively and 2 years postoperatively. Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and PTS were evaluated preoperatively and within 2 years postoperatively. Hinge fractures were investigated using computed tomography at 2 weeks postoperatively. PTS loss was defined as the difference between the corresponding values at 2 weeks and 2 years postoperatively. The incidence of PTS failure (PTS loss ≥ ± 3°) was also investigated.
The clinical results were not significantly different between groups N and S preoperatively and 2 years postoperatively. There were no significant differences in the MA, MPTA, and PTS between the groups preoperatively and 2 weeks postoperatively; changes in these variables did not differ significantly between the groups. The incidence of hinge fractures, all of which were categorized as Takeuchi type 1, did not differ significantly. PTS loss within 2 years postoperatively was significantly greater in group N than in group S (1.0° vs. 0.1°; p < 0.01). The incidence of the PTS failure was 16.5% (13/79) and 2.6% (2/77) in groups N and S, respectively (p < 0.01).
Additional anteromedial staple fixation could prevent changes in the PTS in RT-OWHTO. It is a simple method for preventing an increase in the PTS after RT-OWHTO.
III.
比较Retrotuberosity 双平面开放式楔形胫骨高位截骨术（RT-OWHTO）中附加前内侧钉固定与不附加前内侧钉固定时胫骨后倾角（PTS）的变化。
回顾性分析了 79 例和 77 例分别行 RT-OWHTO 无（N 组）和附加钉固定（S 组）的患者。所有手术均采用锁定垫圈。两组患者的一般资料和术前膝关节状况相似。临床评估包括术前和术后 2 年的 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）和关节活动度。影像学评估包括术前和术后 2 年内的机械轴（MA）、内侧胫骨近端角（MPTA）和 PTS。术后 2 周行 CT 检查以确定有无铰链骨折。将术后 2 周与 2 年时的 PTS 差值定义为 PTS 丢失。还研究了 PTS 失败（PTS 丢失≥±3°）的发生率。
N 组和 S 组术前和术后 2 年的临床结果无显著差异。两组患者术前和术后 2 周的 MA、MPTA 和 PTS 无显著差异；两组间这些变量的变化也无显著差异。铰链骨折的发生率均为 Takeuchi 1 型，无显著差异。N 组术后 2 年内 PTS 丢失明显大于 S 组（1.0°比 0.1°；p<0.01）。N 组 PTS 失败发生率为 16.5%（13/79），S 组为 2.6%（2/77）（p<0.01）。
附加前内侧钉固定可防止 RT-OWHTO 后 PTS 的变化。这是一种预防 RT-OWHTO 后 PTS 增加的简单方法。
III 级。
