内侧开放楔形高位胫骨截骨术外侧合页骨折的处理

Management of lateral hinge fracture in medial open wedge high tibial osteotomy

总结近年国内外有关高位胫骨截骨术、外侧合页骨折的文献,并分析内侧开放楔形高位胫骨截骨术中外侧合页骨折的相关因素及处理策略。发生外侧合页骨折的相关因素包括截骨手术技术、内固定材料、患者自身的因素等方面,预防和处理外侧合页骨折应包括完善术前的设计、提高截骨技术、及时处理不稳定骨折、定期复查观察、调整康复计划、处理骨折造成的不良结局等数方面。目前对外侧合页骨折的处理尚无明确的标准,进一步完善和改进截骨的技术、工具、内固定材料,以及计算机导航、骨科机器人等医学人工智能领域的进步将是提高截骨手术疗效和安全性、降低并发症的必然方向。

To summarize recent literatures concerning the lateral hinge fracture during medial open wedge high tibial osteotomy, and to analyze the related risk factors and the corresponding treatment strategy. The related risk factors of lateral hinge fracture include surgical technique of osteotomy, internal fixation and patient's own factors. Prevention and treatment of lateral hinge fractures should include improvement of preoperative design, enhancement of surgical technical, timely treatment of unstable fractures, periodic review postoperatively, adjustment of rehabilitation plans and management of the adverse consequences due to lateral hinge fracture. At present, there is no guideline for the treatment of lateral hinge fracture in high tibial osteotomy. Along with the further improvement of osteotomy techniques, tools, internal fixations and the great progress in computer navigation, orthopedic robot and other medical artificial intelligence, the efficacy and safety of the osteotomy will improve and surgical complications will reduce obviously in the future.