Kettelkamp D B, Leach R E, Nasca R
Clin Orthop Relat Res. 1975 Jan-Feb(106):232-41. doi: 10.1097/00003086-197501000-00034.
Proximal tibial osteotomy for degenerative genu varus and valgus has an excellent success rate with proper patient selection and technical proficiency. The following are some infrequently recognized pitfalls. Excessive bone loss prevents two plateau weight-bearing after osteotomy, introduces a "teeter effect," and is therefore a contraindication. Patellofemoral arthritis may produce symptoms, particularly on stair climbing and necessitate secondary surgery. Varus and planning indicates postoperative articular surface obliquity in excess of 10 to 15 degrees another type of reconstruction is indicated. Secure fixation, closing wedge osteotomy, and non-displacement of the d-stal fragment prevent loss of correction. Peroneal nerve palsy may be avoided by careful surgical technique and postoperative dressings. Cracking the apical cortex and visualization of the plateau fragment will usually prevent fracture.
对于退行性膝内翻和膝外翻，胫骨近端截骨术在选择合适患者并具备熟练技术的情况下成功率很高。以下是一些较少被认识到的陷阱。过度的骨质流失会妨碍截骨术后双侧平台负重，引发“跷跷板效应”，因此是手术禁忌证。髌股关节炎可能会产生症状，尤其是在爬楼梯时，这就需要进行二次手术。膝内翻及规划显示术后关节面倾斜超过10至15度时，则需采用另一种重建方式。牢固固定、闭合楔形截骨以及远端骨块无移位可防止矫正丢失。通过仔细的手术技术和术后敷料可避免腓总神经麻痹。顶端皮质骨开裂以及观察到平台骨块通常可预防骨折。
