基于计算机断层扫描测量的间隙体积是开放性楔形高位胫骨截骨术后间隙愈合延迟的强风险因素。
Gap Volume Based on Computed Tomography Measurement Is a Strong Risk Factor for Delayed Gap Healing After Open-Wedge High Tibial Osteotomy.
作者信息
Sakai Sayako, Kuriyama Shinichi, Morita Yugo, Nishitani Kohei, Nakamura Shinichiro, Akiyama Takenori, Matsuda Shuichi
机构信息
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
出版信息
Arthroscopy. 2025 May;41(5):1474-1484. doi: 10.1016/j.arthro.2024.07.015. Epub 2024 Jul 26.
PURPOSE
To identify factors that affect delayed gap healing after open-wedge high tibial osteotomy (OWHTO) and to determine whether large gap volume is a predictor of delayed gap healing.
METHODS
This retrospective study analyzed biplane OWHTO performed between 2019 and 2023 for knee osteoarthritis or osteonecrosis. The minimum follow-up period was 1 year. Delayed gap healing was defined when the medial half of the osteotomy gap area had not reached the consolidation phase by 6 months after surgery based on anteroposterior knee radiographs. Gap volume was calculated from computed tomography images. Logistic regression was performed using body height, smoking, correction angle, hinge fracture, flange thickness, and gap volume. A gap volume cutoff value for delayed gap healing was determined with receiver operating characteristic curve analysis. Gap volume was predicted with multiple linear regression.
RESULTS
There were 80 knees in 71 patients (36 men and 44 women). The mean gap volume was 7.6 cm. Gap healing rates at 3, 6, 9, and 12 months after surgery were 26%, 65%, 89%, and 100%, respectively. There were 25 knees with delayed gap healing. Male sex was not a significant risk factor when adjusted for body height. Multivariate logistic regression revealed that only larger gap volume was a significant risk factor (odds ratio, 1.45; P = .006). The gap volume cutoff value was 7.6 cm, with an area under the curve of 0.74. Tall body height and a large correction angle (both P < .001) were associated with a significantly larger gap volume (R = 0.73).
CONCLUSIONS
Large gap volume is the most important risk factor for delayed gap healing after OWHTO. Gap volume can be predicted based on body height and correction angle. When OWHTO with substantial correction is planned for tall men, surgeons should be aware of possibly delayed gap healing.
LEVEL OF EVIDENCE
Level IV, retrospective case-control study.
目的
确定影响开放性楔形高位胫骨截骨术（OWHTO）后间隙延迟愈合的因素，并确定大间隙体积是否为间隙延迟愈合的预测指标。
方法
本回顾性研究分析了2019年至2023年间因膝关节骨关节炎或骨坏死而进行的双平面OWHTO。最短随访期为1年。根据膝关节前后位X线片，当截骨间隙区域的内侧一半在术后6个月时未达到骨愈合阶段，则定义为间隙延迟愈合。间隙体积由计算机断层扫描图像计算得出。使用身高、吸烟情况、矫正角度、铰链骨折、钢板厚度和间隙体积进行逻辑回归分析。通过受试者工作特征曲线分析确定间隙延迟愈合的间隙体积临界值。用多元线性回归预测间隙体积。
结果
71例患者共80膝（男性36例，女性44例）。平均间隙体积为7.6 cm。术后3、6、9和12个月时的间隙愈合率分别为26%、65%、89%和100%。有25膝出现间隙延迟愈合。在对身高进行校正后，男性并非显著的危险因素。多因素逻辑回归显示，只有较大的间隙体积是显著的危险因素（比值比，1.45；P = .006）。间隙体积临界值为7.6 cm，曲线下面积为0.74。高个子身高和大矫正角度（均P < .001）与显著更大的间隙体积相关（R = 0.73）。
结论
大间隙体积是OWHTO后间隙延迟愈合的最重要危险因素。间隙体积可根据身高和矫正角度进行预测。当为高个子男性计划进行需要大量矫正的OWHTO时，外科医生应意识到可能出现间隙延迟愈合。
证据水平
IV级，回顾性病例对照研究。
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