Washington University School of Medicine,St. Louis, MO, USA.
Foot Ankle Int. 2014 Mar;35(3):238-42. doi: 10.1177/1071100713518188. Epub 2013 Dec 26.
A lateral closing wedge osteotomy is used for correction of varus hindfoot deformities. Since its original description, different techniques and geometries of the calcaneal bone wedge resection have been described. Even though the techniques seem similar, very different final bone architectures result from each technique, the effects of which are not known. This paper explores several of these techniques and the implications in deformity correction as well as the secondary effects of calcaneal shortening.
Mathematical and geometric analysis is performed in 2-dimensions for several hypothetical calcaneal osteotomies as described by the original authors. The resulting changes are calculated and compared.
The shape of the bone resection for the lateral closing wedge osteotomy does not result in significantly different final calcaneal architectures. Both techniques studied result in the same amount of calcaneal shortening and deformity correction. However, when lateral calcaneal wedge resection is combined with lateral translation of the tuberosity for additional deformity correction, more calcaneal shortening is seen with posteriorly directed osteotomies than those that are transverse.
The lateral closing wedge osteotomy of the calcaneus results in correction of varus hindfoot deformity at the expense of some calcaneal shortening. Lateral translation of the tuberosity may result in additional calcaneal. The clinical effects of calcaneal shortening or medial soft tissue or nerve tethering from these different techniques are unknown and deserve further investigation.
Level V, expert opinion.
外侧闭合楔形截骨术用于矫正内翻后足畸形。自从最初的描述以来，已经描述了不同的跟骨楔形骨切除技术和几何形状。尽管这些技术看起来相似，但每种技术都会产生非常不同的最终骨结构，其效果尚不清楚。本文探讨了其中的几种技术及其在畸形矫正中的意义，以及跟骨缩短的次要影响。
对几位原作者描述的几种假设性跟骨截骨术进行二维数学和几何分析。计算并比较了所得的变化。
外侧闭合楔形截骨术的骨切除形状不会导致明显不同的最终跟骨结构。研究的两种技术都导致相同量的跟骨缩短和畸形矫正。然而，当外侧跟骨楔形切除与外侧结节的外侧平移相结合以进行额外的畸形矫正时，与横向截骨术相比，后向截骨术导致更多的跟骨缩短。
跟骨外侧闭合楔形截骨术可矫正内翻后足畸形，但会导致一定程度的跟骨缩短。结节的外侧平移可能会导致额外的跟骨缩短。这些不同技术引起的跟骨缩短或内侧软组织或神经束缚的临床效果尚不清楚，值得进一步研究。
五级，专家意见。
