内侧张开楔形胫骨高位截骨术并发外侧合页骨折的研究进展  

Research progrprogress of lateral hinge fractures resulting fromessmedial open wedge high tibial osteotomy

作　　者：谢雪涛[1] 占宇[1] 罗从风[1] XIE Xuetao;ZHAN Yu;LUO Congfeng(Department of Orthopaedics,Shanghai Sixth People's Hospital,Shanghai Jiao Tong University Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中华骨与关节外科杂志》2021年第11期964-970,976,共8页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金(82072419)。

摘　　要：内侧张开楔形胫骨高位截骨术是治疗膝关节内侧间室骨关节炎合并膝内翻畸形的成熟方法之一,其最常见的并发症是外侧合页骨折。分型主要依据骨折线方向、骨折移位程度和发生时间。CT可显著提高该骨折的诊断率。骨折后,截骨区的稳定性下降,易发生延迟愈合或不愈合、目标力线异常、内植物断裂等一系列问题。骨折风险因素与内侧张开距离过大、截骨方式和胫腓骨近端的解剖形态有关。预防措施包括限定外侧合页位于"安全区"内和术中采用克氏针保护等。若一旦发生外侧合页骨折,可通过采用内侧长锁定接骨板、在截骨区植骨、对外侧合页固定和延迟患肢负重等手段来减少或避免进一步的危害。Medial open wedge high tibial osteotomy is one of the established procedures for the treatment of knee medialcompartment osteoarthritis with varus deformity. However, lateral hinge fractures are not uncommon during or after osteotomy,resulting in delayed union or nonunion, abnormal mechanical axis, breakage of medial plates and so on. The fractureclassification is mainly based on the direction of fracture line, displacement degree and occurrence time of fracture. CT cansignificantly improve the diagnosis rate of the fracture. The excessive medial opening distance, osteotomy method and anatomicform of the proximal tibiofibula are risk factors for the fracture. Preventive measures include limiting the lateral hinge in the "safe area" and using Kirschner wire during operation. Once the lateral hinge fracture occurs, we can reduce or avoid furtherharm by using long medial locking plate, bone grafting, lateral hinge fixation and delaying the weight bearing of the affected limb.

关 键 词：内侧张开楔形胫骨高位截骨术 外侧合页骨折 稳定性 

分 类 号：R687.3[医药卫生—骨科学]