Department of Orthopaedic Surgery, Seoul Paik Hospital, Seoul, South Korea.
J Bone Joint Surg Am. 2011 Jul 6;93(13):1243-8. doi: 10.2106/JBJS.J.00249.
Osteotomies are reported to be effective for the treatment of most cases of primary and traumatic moderate osteoarthritis of the ankle joint. Because of unsatisfactory results following supramalleolar tibial osteotomy in several of our patients, we investigated the cause of the unsatisfactory results and the indications for this surgical procedure.
Supramalleolar tibial osteotomy combined with fibular osteotomy was performed in sixteen ankles (sixteen patients) to treat moderate medial ankle osteoarthritis. The median duration of follow-up was 2.3 years (range, one to 6.5 years). Clinical assessment was performed with use of the American Orthopaedic Foot & Ankle Society (AOFAS) scale, and the osteoarthritis stage was determined radiographically with use of the modified Takakura classification system. Clinical and radiographic results were compared among groups defined by high (≥9.5°) or low (≤4°) postoperative talar tilt and by the presence or absence of postoperative lateral subfibular pain. The optimal threshold of preoperative talar tilt for predicting high postoperative talar tilt was determined with use of receiver operating characteristic curve analysis.
The mean AOFAS score, mean Takakura stage, and mean values of all radiographic parameters were improved significantly after surgery. The preoperative talar tilt was correlated with the postoperative talar tilt (Spearman rho = 0.75, p < 0.01). The mean AOFAS score was higher (p = 0.02) and the mean radiographic stage was lower (p = 0.03) in the group with low postoperative talar tilt than in the group with high talar tilt. The optimal threshold for predicting high postoperative talar tilt was 7.3° of preoperative talar tilt, with a sensitivity of 100% and a specificity of 91.7%. The patients with lateral subfibular pain had a lower mean AOFAS score, a greater angle between the tibia and the ankle surface postoperatively, and greater postoperative heel valgus than those without lateral subfibular pain.
Supramalleolar osteotomy is indicated for the treatment of ankle osteoarthritis in patients with minimal talar tilt and neutral or varus heel alignment.
截骨术被报道对大多数原发性和创伤性踝关节中度骨关节炎病例的治疗有效。由于我们的一些患者行胫骨上段截骨术后效果不佳，我们研究了导致手术效果不佳的原因以及该手术适应证。
对 16 例（16 名患者）行胫骨上段截骨术联合腓骨截骨术治疗中内侧踝关节骨关节炎。平均随访时间为 2.3 年（1-6.5 年）。采用美国矫形足踝协会（AOFAS）评分进行临床评估，采用改良 Takakura 分类系统进行影像学评估。比较术后距骨倾斜角高（≥9.5°）与低（≤4°）组、术后是否存在腓骨下段外侧疼痛组之间的临床和影像学结果。采用受试者工作特征曲线分析确定术前距骨倾斜角预测术后距骨倾斜角的最佳阈值。
术后 AOFAS 评分、Takakura 分期平均值和所有影像学参数值均显著改善。术前距骨倾斜角与术后距骨倾斜角相关（Spearman 相关系数=0.75，p<0.01）。术后距骨倾斜角低组的 AOFAS 评分较高（p=0.02），影像学分期较低（p=0.03）。预测术后距骨倾斜角高的最佳阈值为 7.3°的术前距骨倾斜角，敏感性为 100%，特异性为 91.7%。存在腓骨下段外侧疼痛的患者的 AOFAS 评分较低，术后胫骨与踝关节面之间的角度较大，术后跟骨外翻角较大。
胫骨上段截骨术适用于距骨倾斜角小、距骨中立或轻度内翻的踝关节骨关节炎患者。
