Lobenhoffer P, Agneskirchner J, Zoch W
Klinik für Unfall- und Wiederherstellungschirurgie, Henriettenstiftung, Hannover.
Orthopade. 2004 Feb;33(2):153-60. doi: 10.1007/s00132-003-0593-0.
High tibial osteotomy (HTO) is an established technique for the treatment of the symptomatic varus malaligned knee. Correction is usually achieved by closed wedge osteotomy from a lateral exposure. This procedure has a certain risk potential regarding peroneal nerve injuries, instability of the osteotomy and secondary loss of correction. We present four technical modifications of HTO which improve safety and reproducibility of this operation. 1) Open wedge osteotomy from a medial exposure 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. 2) A biplanar osteotomy provides improved rotational stability of the osteotomy and creates an anterior buttress against sagittal tilting. 3) An incomplete osteotomy with plastic deformation of the intact lateral bone bridge avoids fractures of the lateral cortex and instabilities and promotes bone healing. 4) Rigid fixation with a medial plate-fixator (Tomofix) allows for early mobilisation and avoids loss-of-correction. 262 patients were consecutively operated using the described modified technique until now. No loss-of-correction occurred in this group, two patients with delayed healing received secondary cancellous bone grafts.
高位胫骨截骨术（HTO）是治疗有症状的膝内翻畸形膝关节的一种成熟技术。通常通过外侧入路的闭合楔形截骨来实现矫正。该手术在腓总神经损伤、截骨不稳定和继发矫正丢失方面存在一定的潜在风险。我们介绍了HTO的四种技术改良方法，这些方法提高了该手术的安全性和可重复性。1）内侧入路的开放楔形截骨避免了外侧肌肉分离、腓总神经解剖、近端腓骨截骨和肢体缩短。仅需进行一次截骨，且矫正可在术中调整。2）双平面截骨可提高截骨的旋转稳定性，并形成一个防止矢状面倾斜的前支撑。3）不完全截骨并使完整的外侧骨桥发生塑性变形可避免外侧皮质骨折和不稳定，并促进骨愈合。4）使用内侧钢板固定器（Tomofix）进行坚强固定可实现早期活动并避免矫正丢失。截至目前，已有262例患者连续采用上述改良技术进行了手术。该组患者未出现矫正丢失情况，2例愈合延迟的患者接受了二期松质骨移植。
