开放性楔形高位胫骨截骨术与开放性楔形远端胫骨结节截骨术在术后三个月时的骨稳定性是否存在差异？
Is there a difference in bony stability at three months postoperatively between opening-wedge high tibial osteotomy and opening-wedge distal tuberosity osteotomy?
作者信息
Koyama Suguru, Tensho Keiji, Yoshida Kazushige, Shimodaira Hiroki, Kumaki Daiki, Maezumi Yusuke, Horiuchi Hiroshi, Takahashi Jun
机构信息
Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan.
Department of Rehabilitation, Shinshu University Hospital, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan.
出版信息
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2024 Nov 20;39:1-8. doi: 10.1016/j.asmart.2024.10.001. eCollection 2025 Jan.
OBJECTIVE
To compare the initial postoperative stability of opening-wedge high tibial osteotomy (HTO) and opening-wedge distal tuberosity osteotomy (DTO) and investigate the factors that influence initial stability.
METHODS
Patients with the same operative indications who underwent HTO (n = 51) and DTO (n = 55) were included. Demographic and preoperative radiographic data (weight-bearing line percentage [%WBL], femoral-tibial angle [FTA], medial proximal tibial angle [MPTA], posterior tibial slope and correction angle), and postoperative computed tomography (CT) scan data (initial postoperative stability [12 weeks postoperative], and hinge fracture [1 and 12 weeks postoperatively], and hinge length, flange thickness, flange length, axial flange osteotomy angle, sagittal flange osteotomy angle [1 week postoperatively]) were statistically analyzed. As a subgroup analysis, HTO and DTO patients were divided into Stable and Unstable groups respectively based on postoperative CT at 12 weeks; demographic and radiological data were compared.
RESULTS
Patients with DTO was significantly younger (median [range]; 59 [22, 73] vs 64 [45, 75], P = 0.02) and had a smaller preoperative deformity (%WBL: median [range]; 28.9 [12.8, 46.0] vs 24.3 [4.9, 44.3], P < 0.01, FTA: median [range]; 179.0 [173.0, 183.0] vs 180.0 [172.5, 186.2], P < 0.01, MPTA: median [range]; 84.0 [79.0, 87.1] vs 83.0 [78.2, 86.5], P = 0.04) and smaller correction angles (median [range]; 9 [6, 12] vs 10 [7, 15], P < 0.01). Postoperative CT data showed that DTO was associated with significantly more unstable cases (stable/unstable: 31/24 vs. 39/12, P = 0.02) and hinge fractures (none/1/2/3: 24/25/3/3 vs. 36/12/1/2, P < 0.01) and shorter hinge (median [range]; 27.8 [14.7, 43.4] vs 32.6 [22.5, 44.0], P < 0.01) than HTO. The Unstable DTO group had significantly shorter hinges (median [range]; 23.2 [14.7, 33.9] vs 31.1 [15.2, 43.4], P < 0.01) and thicker flanges (median [range]: 15.2 [9.0, 24.8] vs. 11.0 [6.8, 13.8], P < 0.01) than the stable group. The other data were not significantly different between the two groups.
CONCLUSION
DTO resulted in less initial postoperative stability than HTO. The risk factors for initial instability in DTO were a short hinge and thick flange.
目的
比较开放性楔形高位胫骨截骨术（HTO）和开放性楔形远端胫骨结节截骨术（DTO）术后的初始稳定性，并研究影响初始稳定性的因素。
方法
纳入具有相同手术指征且分别接受HTO（n = 51）和DTO（n = 55）的患者。对人口统计学和术前影像学数据（负重线百分比[%WBL]、股胫角[FTA]、胫骨近端内侧角[MPTA]、胫骨后倾角和矫正角度）以及术后计算机断层扫描（CT）数据（术后12周的初始术后稳定性、术后1周和12周的铰链骨折情况，以及铰链长度、翼缘厚度、翼缘长度、轴向翼缘截骨角度、矢状翼缘截骨角度[术后1周]）进行统计分析。作为亚组分析，根据术后12周的CT将HTO和DTO患者分别分为稳定组和不稳定组；比较人口统计学和放射学数据。
结果
接受DTO的患者明显更年轻（中位数[范围]：59[22, 73]岁 vs 64[45, 75]岁，P = 0.02），术前畸形较小（%WBL：中位数[范围]；28.9[12.8, 46.0] vs 24.3[4.9, 44.3]，P < 0.01；FTA：中位数[范围]；179.0[173.0, 183.0] vs 180.0[172.5, 186.2]，P < 0.01；MPTA：中位数[范围]；84.0[79.0, 87.1] vs 83.0[78.2, 86.5]，P = 0.04）且矫正角度较小（中位数[范围]；9[6, 12] vs 10[7, 15]，P < 0.01）。术后CT数据显示，与HTO相比，DTO术后不稳定病例明显更多（稳定/不稳定：31/24 vs. 39/12，P = 0.02），铰链骨折更多（无/1/2/3：24/25/3/3 vs. 36/12/1/2，P < 0.01），铰链更短（中位数[范围]；27.8[14.7, 43.4] vs 32.6[22.5, 44.0]，P < 0.01）。不稳定的DTO组铰链明显更短（中位数[范围]；23.2[14.7, 33.9] vs 31.1[15.2, 43.4]，P < 0.01），翼缘更厚（中位数[范围]：15.2[9.0, 24.8] vs. 11.0[6.8, 13.8]，P < 0.01）。两组间的其他数据无显著差异。
结论
DTO术后的初始稳定性低于HTO。DTO初始不稳定的危险因素是铰链短和翼缘厚。
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