Fractures Around the Lateral Cortical Hinge After a Medial Opening-Wedge High Tibial Osteotomy: A New Classification of Lateral Hinge Fracture
Fractures Around the Lateral Cortical Hinge After a Medial Opening-Wedge High Tibial Osteotomy: A New Classification of Lateral Hinge Fracture
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DOI：
10.1016/j.arthro.2011.06.034
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发表时间：
2012-01-01
影响因子：
4.7
通讯作者：
Saito, Tomoyuki
中科院分区：
文献类型：
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作者：
Takeuchi, Ryohei;Ishikawa, Hiroyuki;Saito, Tomoyuki
目的：研究胫骨高位截骨术后外侧铰链骨折的发生率，探讨骨折类型及其临床转归。方法：对93例患者104个膝关节进行分析，平均年龄68±7岁。在膝关节中，74个被诊断为原发性骨关节炎，30个被诊断为骨坏死。平均随访期为41个月。外侧铰链型骨折分为：I型，骨折到达胫腓关节近端或内；II型，骨折到达胫腓骨近端远端；III型，外侧平台骨折。I型骨折采用标准的术后康复方案，5例II型骨折中有3例采用非负重治疗，III型骨折采用非负重治疗，直至可见骨痂形成。结果：膝关节协会膝关节评分从49+/-11分提高到91+/-7.7分，从62+/-13分提高到95+/-8.2分。外侧皮质骨折26膝(25%)，其中I型19膝，II型5膝，III型2膝。在II型骨折组中，5例患者中有2例骨愈合延迟。在我们的患者队列中，有2例感染(2%)和1例创伤性神经瘤(1%)，但没有植入物失败、骨不连或深静脉血栓形成的情况。结论：接受TomoFix(瑞士，Synths，Bettlach)和骨替代物联合治疗的胫骨高位截骨术患者术后2周能够完全负重行走。19例I型骨折患者均未见并发症。在5例II型骨折患者中，2例延迟愈合，矫正丢失分别为3例和7例。证据级别：IV级，治疗性病例系列。
Purpose: The purpose of this study was to determine the frequency of lateral hinge fractures after opening-wedge high tibial osteotomy and investigate the patterns of fracture and their clinical outcome. Methods: We analyzed 104 knees in 93 patients with a mean age of 68 +/- 7 years. Of the knees, 74 were diagnosed as having primary osteoarthritis and 30 with osteonecrosis. The mean follow-up period was 41 months. Lateral hinge fractures were classified as follows: type I, the fracture reaches just proximal to or within the tibiofibular joint; type II, the fracture reaches the distal portion of the proximal tibiofibular joint; and type III, a lateral plateau fracture. A standard postoperative rehabilitation protocol was used for type I fractures, 3 of 5 patients with type II fractures were treated with non-weight bearing, and type III fractures were treated with non-weight bearing until visible callus formation. Results: The Knee Society scores for the knee and for function showed improvement from 49 +/- 11 to 91 +/- 7.7 points and from 62 +/- 13 to 95 +/- 8.2 points, respectively. Lateral cortex fractures were observed in 26 knees (25%): 19 type I, 5 type II, and 2 type III. In the type II fracture group, 2 of 5 patients were judged to have a delayed bone union. There were 2 cases of infection (2%) and 1 case of traumatic neuroma (1%) but no instances of implant failure, nonunion, or deep vein thrombosis among our patient cohort. Conclusions: High tibial osteotomy patients treated with a combination of TomoFix (Synthes, Bettlach, Switzerland) and bone substitute were able to walk with full weight bearing 2 weeks after surgery. No complications were seen in 19 patients with type I fractures. Of 5 patients with type II fractures, 2 had delayed unions with a correction loss of 3 and 7, respectively. Level of Evidence: Level IV, therapeutic case series.