オカザキ　ケン   KEN OKAZAKI   岡崎　賢    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy.
掲載誌名	正式名：Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 略　 称：Knee Surg Sports Traumatol Arthrosc ISSNコード：14337347/09422056
掲載区分	国外
巻・号・頁	28(5),pp.1372-1379
著者・共著者	Itou Junya, Itoh Masafumi, Maruki Chiyomi, Tajimi Takahiro, So Takaaki, Kuwashima Umito, Okazaki Ken
担当区分	責任著者
発行年月	2020/05
概要	PURPOSE:To assess the risk of injury to the neurovascular bundle on the interosseous membrane of the leg during drilling for distal screw insertion in open-wedge high tibial osteotomy (OWHTO), and to investigate the possible influence of the method of plate placement on the risk.METHODS:This retrospective study involved, 55 patients (32 with a TomoFix plate, 23 with a TriS plate) who underwent postoperative CT scanning of the knee following OWHTO between 2009 and 2018. The angle and position of the locking plate, and the direction of screw insertion relative to the interosseous membrane were analysed.RESULTS:All distal screws had a risk of neurovascular injury. In particular, 25 screws at the #4 hole (45%) had an extended insertion trajectory that intersected with the interosseous membrane. The angle of the proximal part of the TomoFix plate was a significant risk factor. In contrast, methods of TriS plate placement showed no statistically significant differences.CONCLUSIONS:Extended insertion trajectories of distal screws were likely to intersect with the interosseous membrane with the neurovascular bundle potentially on its surface; thus, drilling for bicortical fixation posed a risk of neurovascular injury. The risk increased as the TomoFix plate was placed more medially, suggesting that bicortical drilling must be performed with the utmost attention when the plate is placed at the medial position. Given the particularly high risk at the #3 and #4 screw holes, monocortical fixation of a few distal screws is recommended as long as good stability is ensured.
DOI	10.1007/s00167-019-05445-y
PMID	30834477