Foot Ankle Int. 2012 Apr;33(4):255-61. doi: 10.3113/FAI.2012.0255.
Although supramalleolar osteotomy with an opening medial wedge or a closing lateral wedge have been described for varus ankle deformity, these may be associated with failure due to persistence of the medial intra-articular defect, resulting in recurrent varus deformity. We report the results of a retrospective study assessing the outcome of an intra-articular opening wedge osteotomy of the distal medial tibia (plafond-plasty) for intra-articular varus ankle deformity associated with osteoarthritis and ankle instability.
The results of 19 plafond-plasties in 19 patients for correction of intra-articular varus osteoarthritis of the ankle associated with ankle instability were reviewed. Fourteen men and five women of a mean age of 47 (range, 32 to 63) years were treated. Followup ranged from 14 to 98 (mean, 59) months.
Lateral ligament reconstruction was done at the time of the surgery in 18 out of 19 patients. The radiographic parameters including the TAS and TAL showed no statistical significant improvement when compared pre and post operatively. The varus ankle tilt deformity improved from 18 degrees preoperatively to 10 degrees postoperatively (p < 0.05). The pre- and postoperative AOFAS score improved significantly from 46 to 78, respectively (p < 0.05). Two patients underwent ankle arthrodesis at 7 and 36 months, and two patients underwent ankle replacement at 30 and 48 months following the index procedure. Of the remaining 15 patients, 14 reported stable or very stable ankles, and 15 of the 19 were either satisfied or very satisfied with the outcome of treatment.
These results demonstrate that plafond-plasty osteotomy associated with lateral ligament reconstruction may be a suitable for patients presenting with intra-articular varus ankle osteoarthritis associated with ankle instability, providing pain relief and better function and stability in most patients.
虽然已经描述了用于踝内翻畸形的距下骨切开术和内侧楔形切开术或外侧楔形闭合术，但这些手术可能会由于内侧关节内缺陷的持续存在而导致失败，从而导致内翻畸形复发。我们报告了一项回顾性研究的结果，该研究评估了用于治疗与踝关节不稳定相关的关节内内翻踝关节炎的关节内内侧胫骨楔形切开术（距下成形术）的结果。
回顾性分析了 19 例 19 例距下成形术治疗与踝关节不稳定相关的关节内内翻性骨关节炎的患者。 14 例男性和 5 例女性，平均年龄为 47 岁（范围 32 至 63 岁）。随访时间为 14 至 98 个月（平均 59 个月）。
19 例患者中有 18 例在手术时进行了外侧韧带重建。与术前相比，术后 TAS 和 TAL 等影像学参数无统计学显著改善。术前内翻踝倾斜畸形从 18 度改善至 10 度（p <0.05）。术前和术后 AOFAS 评分分别从 46 分显著改善至 78 分（p <0.05）。 2 例患者分别在术后 7 个月和 36 个月行踝关节融合术，2 例患者分别在术后 30 个月和 48 个月行踝关节置换术。在其余 15 例患者中，14 例报告踝关节稳定或非常稳定，19 例中有 15 例对治疗结果满意或非常满意。
这些结果表明，与外侧韧带重建相关的距下成形术可能适合于存在与踝关节不稳定相关的关节内内翻踝关节炎的患者，可为大多数患者提供缓解疼痛和更好的功能和稳定性。
