Hintermann Beat, Ruiz Roxa, Barg Alexej
1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland.
2 Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
Foot Ankle Int. 2017 Sep;38(9):970-981. doi: 10.1177/1071100717712543. Epub 2017 Jul 1.
A most challenging condition for balancing a varus arthritic ankle is the presence of a defect in the medial tibial plafond. After our initial results with a medial tibial plafondplasty did not fulfill our expectations of success, we hypothesized that adding a correcting supramalleolar osteotomy of the distal tibia would move the loading force to the tibiotalar joint more medially and move the center of rotation of the talus more laterally. In this study, we analyzed midterm clinical and radiographic outcomes in patients with double tibial osteotomy.
Between January 2005 and February 2010, 20 patients were treated with a medial tibial plafondplasty and a medial supramalleolar osteotomy of the distal tibia. The mean age of the patients was 44 ± 12 years (range, 17-60 years). Follow-up averaged 5.9 ± 2.1 years (range, 4-11.2 years). Weight-bearing radiographs were used to assess osteotomy union and hindfoot alignment.
There were no intraoperative or perioperative complications. The average VAS pain score decreased significantly from 7.9 ± 1.3 (range, 6-10) to 1.3 ± 1.6 (range, 0-7). The average AOFAS hindfoot score increased significantly from 49 ± 15 points (range, 36-68) preoperatively to 86 ± 12 points (range, 66-96) postoperatively. The varus tilt improved significantly from 19.4° ± 8.2° (range, 6°-32°) to 6.9° ± 3.9° (range, 1°-12°).
The novel double osteotomy was found to be an efficient and successful method to restore tibiotalar joint congruency and to normalize hindfoot alignment.
Level IV, prospective cohort study.
对于内翻性关节炎踝关节平衡而言，最具挑战性的情况是胫骨内侧平台存在缺损。在胫骨内侧平台成形术的初步结果未达到我们预期的成功效果后，我们推测增加远端胫骨的矫正性距上截骨术会使加载力更向内侧转移至胫距关节，并使距骨的旋转中心更向外侧移动。在本研究中，我们分析了接受双胫骨截骨术患者的中期临床和影像学结果。
2005年1月至2010年2月期间，20例患者接受了胫骨内侧平台成形术和远端胫骨内侧距上截骨术。患者的平均年龄为44±12岁（范围17 - 60岁）。随访平均为5.9±2.1年（范围4 - 11.2年）。负重X线片用于评估截骨愈合和后足对线情况。
术中及围手术期均无并发症。平均视觉模拟评分（VAS）疼痛评分从7.9±1.3（范围6 - 10）显著降至1.3±1.6（范围0 - 7）。美国足踝外科协会（AOFAS）后足评分术前平均为49±15分（范围36 - 68），术后显著提高至86±12分（范围66 - 96）。内翻倾斜度从19.4°±8.2°（范围6° - 32°）显著改善至6.9°±3.9°（范围1° - 12°）。
新型双截骨术被发现是恢复胫距关节一致性和使后足对线正常化的一种有效且成功的方法。
IV级，前瞻性队列研究。
