Lobenhoffer Philipp, Agneskirchner Jens D
Department of Trauma and Reconstructive Surgery, Henriettenstiftung Hannover, Marienstrasse 72-90, 30171 Hanover, Germany.
Knee Surg Sports Traumatol Arthrosc. 2003 May;11(3):132-8. doi: 10.1007/s00167-002-0334-7. Epub 2003 Jan 11.
We present four technical modifications of high tibial osteotomy which improve its safety and reproducibility. (a) Open wedge correction: opening wedge osteotomy from the medial side avoids lateral muscle detachment, dissection of the peroneal nerve, proximal fibula osteotomy, and leg shortening; only one osteotomy needs to be performed and the correction can be adapted intraoperatively. (b) Biplanar osteotomy: in addition to the transverse osteotomy of the posterior tibia a second ascending osteotomy in the coronary plane underneath the tibial tuberosity is performed. This provides improved rotational stability of the osteotomy and creates an anterior buttress against sagittal tilting of the osteotomy planes. (c) Incomplete osteotomy with plastic deformation of the tibia: 10 mm of lateral bone stock is left intact. The osteotomy is opened gradually over several minutes by sequential impaction of flat chisels or by use of a special spreading tool. Manifest fractures of the lateral cortex with resulting instability are avoided. Rapid bone healing is promoted. (d) Rigid fixation: stable osteosynthesis allows for early mobilization and avoids losses-of-correction. We use a medial plate-fixator which can be applied percutanously. In 112 patients operated on using this modified technique no pseudarthosis or loss-of-correction was observed.
我们介绍了四种胫骨高位截骨术的技术改良方法，这些方法提高了该手术的安全性和可重复性。（a）开放楔形矫正：从内侧进行开放楔形截骨可避免外侧肌肉附着分离、腓总神经解剖、近端腓骨截骨以及腿部缩短；仅需进行一次截骨，且矫正可在术中进行调整。（b）双平面截骨：除了胫骨后部的横向截骨外，还在胫骨结节下方的冠状面进行第二次斜向上的截骨。这提高了截骨的旋转稳定性，并形成了一个防止截骨平面矢状面倾斜的前支撑。（c）胫骨不完全截骨并伴有塑性变形：保留10毫米外侧骨皮质完整。通过依次用平凿冲击或使用特殊撑开工具，在几分钟内逐渐打开截骨处。避免外侧皮质出现明显骨折及由此导致的不稳定情况。促进快速骨愈合。（d）坚强内固定：稳定的骨固定可实现早期活动，并避免矫正丢失。我们使用一种可经皮应用的内侧钢板固定器。采用这种改良技术对112例患者进行手术，未观察到假关节形成或矫正丢失的情况。
