Kim Seung-Min, Bin Seong-Il, Kim Jong-Min, Lee Bum-Sik, Lee Hyo-Yeol, Lee Seon-Jong
Department of Orthopaedic Surgery, Wiltse Memorial Hospital, Anyang, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Arthroscopy. 2024 Mar;40(3):890-895. doi: 10.1016/j.arthro.2023.07.054. Epub 2023 Aug 14.
To verify whether the distance from the hinge point to the tibial cortex affects the occurrence time and characteristics of the lateral hinge fracture (LHF) in medial open-wedge high tibial osteotomy.
We retrospectively reviewed 171 knees in 171 patients (121 women, 50 men; mean age, 53.9 years; range, 36-67 years) who had undergone medial open-wedge high tibial osteotomy with locking plate fixation between January 2011 and December 2020. Osteotomy hinge point and LHFs were identified on intraoperative fluoroscopy and immediate postoperative radiographs. LHF type was classified as suggested by Takeuchi et al. Acute fracture was defined as a fracture that occurred during surgery, and delayed fracture was defined as a fracture observed after 1 month postoperatively. The nearest distances from osteotomy hinge point to lateral, distal, and proximal cortex were measured on postoperative radiographs. We compared the distance between the different types and between acute and delayed LHFs.
There were 55 LHFs (32%) (type I, 40 knees; type II, 14 knees; type III, 1 knee) that occurred acutely in 41 knees and were found as delayed fractures in 14 knees. The patient demographics were not significantly different between non-LHFs and each type of LHFs. Proximal and distal distances were not statistically different among fracture types and between occurrence times. However, lateral distances were significantly shorter in type I LHFs (6.2 ± 1.8 mm) and longer in type II LHFs (9.3 ± 2.3 mm) than in non-LHFs (7.1 ± 2.7 mm) (P = .020 and .004, respectively). The lateral cortical distances were also different between acute LHFs (6.4 ± 1.9 mm) and delayed LHF (9.0 ± 2.7 mm) (P < .001). In the case of fracture type, the frequency of type I decreases with increase in the lateral distance, whereas that of type II increases with increase in the lateral cortical distance. In acute fracture, type I was dominant (85.4%), whereas in delayed fracture, type II was dominant (57.2%).
The lateral cortical distance from the hinge point was significantly associated with LHF occurrence. Shorter distance increased the risk for acute type I LHF, whereas longer distance increased the risk for delayed type II LHFs.
Level III, retrospective comparative prognostic trial.
验证在胫骨内侧开放性高位截骨术中，从铰链点到胫骨皮质的距离是否会影响外侧铰链骨折（LHF）的发生时间和特征。
我们回顾性分析了2011年1月至2020年12月期间接受胫骨内侧开放性高位截骨并使用锁定钢板固定的171例患者（121例女性，50例男性；平均年龄53.9岁；范围36 - 67岁）的171个膝关节。通过术中透视和术后即刻X线片确定截骨铰链点和LHF。LHF类型按照Takeuchi等人的建议进行分类。急性骨折定义为手术过程中发生的骨折，延迟性骨折定义为术后1个月后观察到的骨折。在术后X线片上测量从截骨铰链点到外侧、远端和近端皮质的最短距离。我们比较了不同类型之间以及急性和延迟性LHF之间的距离。
共发生55例LHF（32%）（I型40例；II型14例；III型1例），其中41例为急性骨折，14例为延迟性骨折。非LHF组与各类型LHF组患者的人口统计学特征无显著差异。骨折类型之间以及发生时间之间的近端和远端距离无统计学差异。然而，I型LHF的外侧距离（6.2±1.8mm）显著短于非LHF组（7.1±2.7mm）（P分别为0.020和0.004），II型LHF的外侧距离（9.3±2.3mm）显著长于非LHF组。急性LHF（6.4±1.9mm）和延迟性LHF（9.0±2.7mm）的外侧皮质距离也存在差异（P<0.001）。就骨折类型而言，I型的频率随外侧距离增加而降低，而II型的频率随外侧皮质距离增加而增加。在急性骨折中，I型占主导（85.4%），而在延迟性骨折中，II型占主导（57.2%）。
从铰链点到外侧皮质的距离与LHF的发生显著相关。距离较短增加了急性I型LHF的风险，而距离较长增加了延迟性II型LHF的风险。
III级，回顾性比较预后试验。
