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首页> 外文期刊>Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology >Stress fractures of the lateral tibial plateau after open wedge high tibial osteotomy could be delayed type III lateral hinge fractures
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Stress fractures of the lateral tibial plateau after open wedge high tibial osteotomy could be delayed type III lateral hinge fractures

机译：开放楔形高位胫骨截骨术后胫骨外侧平台的应力性骨折可延迟III型外侧铰链骨折

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PurposeTo examine the condition and triggers of stress fractures of the lateral tibial plateau (LTP) similar to type III lateral hinge fractures (LHFs) after open wedge high tibial osteotomy (OWHTO).MethodsOWHTO was performed in 118 knees. They were examined for LHFs by computed tomography (CT). Patients were divided into the stress fracture group (Group SF) if they showed fracture lines on CT performed after starting weight-bearing walking and the normal group (Group N) for others.ResultsThe mean age was significantly older in Group SF (P?=?0.022). Preoperatively, Group SF showed a significantly higher tibio-femoral angle (TFA, P?=?0.014). No significant differences were observed in TFA and weight-bearing line ratio after surgery. Correction angle was significantly higher in the SF group. And all of the SF were more than 13 degrees. There was no significant difference in LHF incidence between groups, whereas stress fracture incidence differed significantly for each type of LHF (chi-squared test, P?=?0.0001): 14.6% of type I cases, 100% of type II cases, 0% of type III cases, and 6.1% of those without LHF.DiscussionThe load on the LTP is assumed to act as a shearing force in type II fractures, which may contribute greatly to stress fractures. In type III, stress fractures may not occur because of the load dispersed at the fracture part. The stress fracture site is similar to type III LHF, and this kind of fracture is thought to be a delayed type III because it occurs after patients start weight-bearing walking. Moreover, they are observed in type I cases with a stable hinge and in 6% of cases without LHF. This study showed that high varus knees corrected with a large correction angle may develop stress fractures. OWHTO requires attention to stress fractures of the LTP, which can be regarded as delayed type III, in those developing LHFs postoperatively or having a high varus knee preoperatively.ConclusionThese results indicated the possibility of stress fracture in LTP during weight-bearing exercise after OWHTO, which was regarded as a delayed type III fracture. The results showed that Correction angle was more than 13 degrees, and lateral hinge fracture type II of the Takeuchi classification was an inducement of this stress fracture.Level of evidenceLevel IV.
机译：目的探讨类似于开放式楔形高位胫骨截骨术（OWHTO）后III型外侧铰链骨折（L​​HFs）的胫骨外侧平台（LTP）应力性骨折的病因和诱因。方法在118膝中进行OWHTO。通过计算机断层扫描（CT）检查他们的LHF。如果患者开始负重行走后在CT上显示骨折线，则将其分为应力性骨折组（SF组），其他患者则分为正常组（N组）。结果SF组的平均年龄明显偏大（P = （0.022）。术前，SF组显示出较大的胫股角（TFA，P = 0.014）。术后TFA和负重线比例无明显差异。 SF组的矫正角明显更高。并且所有的SF都超过13度。两组之间的LHF发生率无显着差异，而每种类型的LHF的应力性骨折发生率却有显着差异（卡方检验，P≥0.0001）：I型病例为14.6％，II型病例为100％，0 III型病例的百分比，无LHF的病例的6.1％。讨论LTP的载荷被认为是II型骨折的剪切力，可能对应力性骨折起很大作用。在III型中，由于载荷分散在断裂部位，因此可能不会发生应力断裂。应力性骨折部位类似于III型LHF，这种骨折被认为是延迟性III型骨折，因为它发生在患者开始负重步行之后。此外，在具有稳定铰链的I型病例和没有LHF的6％病例中观察到它们。这项研究表明，以较大的矫正角矫正的高内翻膝盖可能会产生应力性骨折。 OWHTO需要注意LTP的应力性骨折，在术后发展为LHF或术前膝内翻高的患者中，LTP可能被认为是延迟性III型。结论这些结果表明，在OWHTO负重运动期间，LTP可能发生应力性骨折，被认为是Ⅲ型延迟骨折。结果表明，矫正角大于13度，而Takeuchi分类的II型侧向铰链骨折是这种应力性骨折的诱因。

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