Niemeyer P, Stöhr A, Köhne M, Hochrein A
Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
OCM Klinik GmbH, München, Deutschland.
Oper Orthop Traumatol. 2017 Aug;29(4):294-305. doi: 10.1007/s00064-017-0509-5. Epub 2017 Jun 22.
Reduction of the load to the medial compartment in patients with medial knee osteoarthritis and varus malalignment. Unloading of the posterolateral complex in varus deformity with complex ligamentous laxity.
Medial knee osteoarthritis and varus malalignment with largely intact lateral and patellofemoral joint aspect. Complex ligament insufficiency combined with varus deformity.
Substantially impaired range of motion.
Medial skin incision on the proximal lower leg. Preparation of the pes anserinus. Marking of the osteotomy from the deepest point of the medial metaphysis laterally ascending. Biplane osteotomy, carefully protecting the posterior neurovascular structures, with ventral completion proximal or distal to the tibial tuberosity, depending on concomitant pathologies. Angular-stable plate fixation.
In general, early weight bearing is possible when angular-stable plate fixation is used. Often concomitant pathologies such as accompanying cartilage regenerative therapy necessitate longer unloading. Range of motion does not need to be restricted following stand-alone osteotomy. Orthoses are recommended regularly.
Under the correct indication, the medial opening wedge high tibial osteotomy (OW-HTO) technique can achieve good results with high patient satisfaction, despite a relatively high statistical complication rate, provided that a standardized surgical technique is used. There is a tendency for a poorer outcome in patients with a body mass index above 30 and higher stages of osteoarthritis.
减轻膝内侧骨关节炎和内翻畸形患者内侧间室的负荷。减轻伴有复杂韧带松弛的内翻畸形患者后外侧复合体的负荷。
膝内侧骨关节炎和内翻畸形，外侧和髌股关节面基本完整。复杂韧带功能不全合并内翻畸形。
活动范围严重受损。
小腿近端内侧皮肤切口。准备鹅足。从内侧干骺端最深点向外上方标记截骨线。双平面截骨，小心保护后方神经血管结构，根据伴随的病变情况，在胫骨结节近端或远端完成腹侧截骨。使用角稳定钢板固定。
一般来说，使用角稳定钢板固定时可早期负重。常伴有软骨再生治疗等病变，需要更长时间的负荷减轻。单纯截骨术后无需限制活动范围。建议定期使用矫形器。
在正确的适应症下，内侧开口楔形高位胫骨截骨术（OW-HTO）技术尽管统计并发症发生率相对较高，但只要采用标准化手术技术，就能取得良好效果，患者满意度高。体重指数高于30和骨关节炎晚期患者的预后往往较差。
