Ogawa Hiroyasu, Nakamura Yutaka, Sengoku Masaya, Shimokawa Tetsuya, Ohnishi Kazuichiro, Akiyama Haruhiko
Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan.
Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, Gifu, 503-0015, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2024 Jul 2;37:21-26. doi: 10.1016/j.asmart.2024.01.005. eCollection 2024 Jul.
This study aimed to evaluate bone union of the tibial tuberosity in patients undergoing medial opening wedge distal tibial tuberosity osteotomy (OWDTO). It was hypothesized that bone union of the tibial tuberosity could be associated with lateral hinge fractures (LHFs), but not thickness of the tibial tuberosity osteotomy.
Data of 61 consecutive patients who underwent OWDTO were retrospectively reviewed. Radiographic parameters of the lower limb and LHFs were evaluated. Thickness of the tibial tuberosity osteotomy and bone union of the tibial tuberosity were assessed at 1, 2, 3, 4, and 5 cm distal to the most proximal part of the tibial tuberosity on computed tomography. Bone union was assessed. Factors related to bone union of the tibial tuberosity were analyzed.
There were 13 postoperative onset LHFs: all healed with conservative treatments within 6 months after surgery. The total score of bone union of the tibial tuberosity was 8.4 ± 2.1 points, which correlated with age, postoperative medial proximal tibial angle (MPTA), correction angle, and postoperative onset LHF (r = 0.307, 0.388, 0.275, and -0.624, respectively; = 0.016, 0.002, 0.033, and <0.001, respectively). Regression coefficient for postoperative onset LHF, postoperative MPTA, and body mass index were -0.619 ( < 0.001), 0.285 ( = 0.003), and -0.227 ( = 0.021), respectively.
Postoperative onset LHFs, but not thickness of the tibial tuberosity osteotomy, were a risk factor for delayed union of the tibial tuberosity following OWDTO. Furthermore, to prevent delayed union of the tibial tuberosity, postoperative onset LHFs should be prevented.
LEVEL III, Case-control study.
本研究旨在评估接受胫骨远端结节内侧开口楔形截骨术（OWDTO）患者的胫骨结节骨愈合情况。研究假设胫骨结节骨愈合可能与外侧铰链骨折（LHFs）有关，但与胫骨结节截骨厚度无关。
回顾性分析61例连续接受OWDTO患者的数据。评估下肢的影像学参数和LHFs。在计算机断层扫描上，于胫骨结节最近端以远1、2、3、4和5 cm处评估胫骨结节截骨厚度和胫骨结节骨愈合情况。评估骨愈合情况。分析与胫骨结节骨愈合相关的因素。
术后发生13例LHFs：均在术后6个月内通过保守治疗愈合。胫骨结节骨愈合的总评分为8.4±2.1分，其与年龄、术后胫骨近端内侧角（MPTA）、矫正角度及术后发生的LHF相关（r分别为0.307、0.388、0.275和 -0.624；P分别为0.016、0.002、0.033和<0.001）。术后发生的LHF、术后MPTA及体重指数的回归系数分别为 -0.619（P<0.001）、0.285（P = 0.003）和 -0.227（P = 0.021）。
OWDTO术后发生的LHFs而非胫骨结节截骨厚度是胫骨结节延迟愈合的危险因素。此外，为预防胫骨结节延迟愈合，应预防术后发生LHFs。
III级，病例对照研究。
