Zhao Hong-Mou, Liang Xiao-Jun, Li Yi, Ning Ning, Lu Jun
Orthopedist, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
Professor and Chief, Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
J Foot Ankle Surg. 2017 Sep-Oct;56(5):1125-1128. doi: 10.1053/j.jfas.2017.04.022. Epub 2017 May 27.
We treated a 57-year-old female with modified Takakura stage 3B varus ankle osteoarthritis. Her preoperative talar tilt angle was 21.3°. The patient wished to avoid ankle joint arthrodesis or replacement. Therefore, medial opening wedge supramalleolar osteotomy with fibular osteotomy was used for her varus ankle osteoarthritis. Also, fixed medial distraction arthroplasty was performed to improve her talar tilt. After 3 months, the external device was removed, and the patient was allowed partial weightbearing and began full weightbearing 4 months postoperatively after the osteotomy site had reached bony union radiographically. At the 3-year follow-up visit, a radiograph showed the medial ankle joint space enlargement had been maintained. The talar tilt angle had decreased to 3.3°, and the modified Takakura stage had improved to stage 1. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score had improved from 26 points preoperatively to 85 points at 3 years postoperatively. Our findings suggested that good clinical and radiologic results can be achieved with supramalleolar osteotomy combined with distraction arthroplasty in the treatment of varus ankle osteoarthritis with a large talar tilt angle.
我们治疗了一名57岁的女性，她患有改良Takakura 3B期内翻踝关节骨关节炎。她术前的距骨倾斜角为21.3°。患者希望避免踝关节融合术或置换术。因此，采用内侧开放楔形距上截骨术联合腓骨截骨术治疗她的内翻踝关节骨关节炎。此外，还进行了固定内侧撑开关节成形术以改善她的距骨倾斜。3个月后，拆除外部固定装置，患者可部分负重，并在截骨部位影像学显示达到骨愈合后于术后4个月开始完全负重。在3年的随访中，X线片显示踝关节内侧间隙增宽得以维持。距骨倾斜角降至3.3°，改良Takakura分期改善至1期。美国矫形足踝协会（AOFAS）踝-后足评分从术前的26分提高到术后3年的85分。我们的研究结果表明，距上截骨术联合撑开关节成形术治疗距骨倾斜角较大的内翻踝关节骨关节炎可取得良好的临床和影像学效果。
