rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2018-641-648rsp-2629Research ArticleРЕВМООРТОПЕДИЯ И РЕАБИЛИТАЦИЯORTHOPEDIC RHEUMATOLOGY AND REHABILITATIONОсложнения открывающей угол высокой тибиальной остеотомииCOMPLICATIONS OF OPENING WEDGE HIGH TIBIAL OSTEOTOMYБяликВ. Е.ByalikV. E.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

DoctorBjalik@yandex.ruМакаровС. А.MakarovS. A.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

АлексееваЛ. И.AlekseevaL. I.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

БяликЕ. И.ByalikE. I.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

АрхиповС. В.ArkhipovS. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ГлуховаС. И.GlukhovaS. I.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

НурмухаметовМ. Р.NurmukhametovM. R.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

НестеренкоВ. А.NesterenkoV. A.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation201809112018565641648Copyright © Бялик В.Е., Макаров С.А., Алексеева Л.И., Бялик Е.И., Архипов С.В., Глухова С.И., Нурмухаметов М.Р., Нестеренко В.А., 20182018Бялик В.Е., Макаров С.А., Алексеева Л.И., Бялик Е.И., Архипов С.В., Глухова С.И., Нурмухаметов М.Р., Нестеренко В.А.Byalik V.E., Makarov S.A., Alekseeva L.I., Byalik E.I., Arkhipov S.V., Glukhova S.I., Nurmukhametov M.R., Nesterenko V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2629

Открывающая угол высокая тибиальная остеотомия (ОУ ВТО) – метод хирургического лечения остеоартрита (ОА) коленного сустава (КС) с преимущественным поражением медиального отдела, позволяющий восстановить механическую ось нижней конечности, перенести нагрузку с пораженного медиального отдела КС на интактный латеральный отдел, и, таким образом, замедлить прогрессирование ОА, уменьшить или вовсе купировать боль, продлить функцию собственного КС и отдалить тотальное эндопротезирование КС (ТЭКС). Как при любом оперативном вмешательстве, при ОУ ВТО могут развиться общие, местные и специфические для данной операции осложнения.Цель исследования – изучить осложнения ОУ ВТО, определить влияние дизайна коротких пластин со спейсером, костного трансплантата и/или остеозамещающих материалов, а также возраста, массы тела и величины угла коррекции на развитие осложнений у больных, перенесших данное оперативное вмешательство.Материал и методы. За период с 2003 по 2016 г. было выполнено 28 ОУ ВТО у 26 пациентов. Соотношение мужчин и женщин составило примерно 2:1. Средний возраст был равен 58,21+11,24 года, индекс массы тела (ИМТ) – 28,56+3,61 кг/м2, а угол коррекции –11,8+2,4°. Фиксацию осуществляли при помощи коротких пластин со спейсером трех разных дизайнов: Puddu plate I, II и Osteomed. Костную пластику выполняли при помощи аутотрансплантата из крыла подвздошной кости, либо биодеградируемым остеозамещающим материалом – β-трикальций фосфатом – в форме прямоугольных блоков, либо Inject. При размере клина <10 мм костную пластику не выполняли.Результаты и обсуждение. В 11 случаях из 28 (39,25%) было диагностировано 12 осложнений. Из них было 8 случаев боли в области имплантированной пластины, три внутрисуставных перелома латерального тибиального плато и одно нарушение полимеризации жидкого β-трикальций фосфата. Статистически достоверных связей исследуемых параметров с развитием осложнений выявлено не было.Заключение. Осложнения, связанные с фиксатором, развиваются с одинаковой частотой независимо от дизайна коротких пластин со спейсером. Применения жидкой формы β-трикальций фосфата следует избегать при закрытии остеотомического клина. Возраст, масса тела и величина угла коррекции не ассоциированы с развитием осложнений при ОУ ВТО.

Opening wedge high tibial osteotomy (OWHTO) is a surgical treatment option for osteoarthritis (OA) of the knee with a predominant lesion of its medial segment, which can restore the mechanical axis of the lower limb, transfer load from affected medial to intact lateral part of knee joint, and thus slow OA progression, reduce or even abolish pain, prolong the function of the patient’s own knee joint, and delay total knee arthroplasty. Like any surgical intervention, OWHTO can be responsible for common, local, and specific surgical complicationsObjective: to investigate complications from OWHTO and to determine the impact of the design of short spacer plates, bone graft materials and/or bone substitutes, as well as age, body weight and wedge angle correction on the development of complications in patients undergoing this surgery.Subjects and methods. Twenty-eight OWHTOs were performed in 26 patients in 2003 to 2016. The male and female ratio was approximately 2:1. The patients’ mean age was 58.1±11.24 years; body mass index, 28.56±3.61 kg/m2; correction angle, 11.8±2.4°. Fixation was carried out using short spacer plates of three different designs: Puddu plate I, II, and Osteomed. Bone grafting was performed applying an iliac wing autograft or a biodegradable bone substitute (β-tricalcium phosphate) as rectangular blocks, or Inject. Bone grafting was not done when the wedge size was <10 mm.Results and discussion. Twelve complications were diagnosed in 11 of the 28 (39.25%) cases. Of these, there were 8 cases of pain at the site of the implanted plate, three intra-articular fractures of the lateral tibial plateau, and one case of impaired polymerization of liquid β-tricalcium phosphate. There were no statistically significant relationships between the parameters investigated and the development of complications.

Conclusion. Clamp-associated complications develop with the same frequency regardless of the design of short spacer plates. The use of liquid β-tricalcium phosphate should be avoided in closing wedge osteotomy. Age, body weight, and the magnitude of a correction angle are unassociated with the development of complications in OWHTO. 

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The authors declare that there are no conflicts of interest present.