Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Department of Orthopaedics and Sports Medicine, University of Washington-Harborview Medical Center, Seattle, Washington 98195 USA.
HSS J. 2013 Feb;9(1):90-5. doi: 10.1007/s11420-012-9271-2. Epub 2012 Jun 14.
Proximal tibiofibular joint (PTFJ) instability is rare, but when encountered can be difficult to manage. Previously reported forms of treatment, including cast immobilization, soft tissue repairs and reconstructions, and fibular head resection have met with limited success. Another option is PTFJ arthrodesis-however, fusion can be difficult and ankle pain after surgery is not uncommon. In this report, we present a novel surgical technique used to treat PTFJ instability. It is a form of PTFJ arthrodesis that utilizes the osteoinductive agent recombinant human osteogenic protein (rhOP-1) to help achieve fusion, in conjunction with a fibular osteotomy to unload the PTFJ and to preserve normal rotator mobility of the distal fibula during ankle motion. We have used this technique in two patients with successful results; one of whom required revision after two previous failed attempts at PTFJ fusion and the other who had a previous diagnosis of underlying collagen disorder. Their case studies are presented in detail in this report.
胫骨腓骨关节（PTFJ）不稳定较为罕见，但一旦出现，治疗就会很棘手。既往报道的治疗方法包括石膏固定、软组织修复和重建以及腓骨头切除术，但这些方法的疗效有限。另一种选择是 PTFJ 融合术——然而，融合可能很困难，术后踝关节疼痛也并不少见。在本报告中，我们介绍了一种用于治疗 PTFJ 不稳定的新手术技术。这是一种 PTFJ 融合术，使用了诱导成骨蛋白（rhOP-1）这种有骨诱导活性的药物来帮助实现融合，并结合腓骨截骨术来减轻 PTFJ 的负荷，同时在踝关节运动时保持腓骨远端的正常旋转活动度。我们在两名患者中使用了这种技术，均取得了成功的结果；其中一名患者在两次 PTFJ 融合失败后进行了翻修，另一名患者曾被诊断为潜在的胶原疾病。本报告详细介绍了这两例患者的病例研究。
