1 Duke University Medical Center, Durham, NC, USA.
2 Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2018 Aug;39(8):970-977. doi: 10.1177/1071100718768225. Epub 2018 Apr 4.
Few authors have directly compared multiple types of lateralizing calcaneal osteotomies (LCOs) in terms of their ability to achieve deformity correction. The aim of this research was to use a digital model of a varus hindfoot to compare 4 different LCOs in terms of deformity correction and amount of tuberosity lateralization required. The authors hypothesis was that osteotomies involving a wedge resection would achieve greater correction with less lateralization.
A weightbearing computed tomographic scan of a patient with a varus hindfoot deformity was used to construct a 3-dimensional digital model of the hindfoot, preserving weightbearing alignment. Four different LCOs were modeled: a standard oblique osteotomy, a Dwyer osteotomy, a modified Dwyer osteotomy involving lateralization in addition to wedge resection, and a Malerba Z-type osteotomy with wedge resection and lateralization. Incremental corrections were performed with each osteotomy type, and amount of correction was assessed with a vertical hindfoot angle and measurement of the lateral translation of the most inferior aspect of the calcaneus. Calcaneal length and osteotomy contact surface area were also measured.
The modified Dwyer osteotomy led to the greatest improvements in the vertical hindfoot angle and lateral translation, followed by the Malerba osteotomy. The standard and Malerba osteotomies allowed the most preservation of calcaneal length; the Malerba and Dwyer osteotomies had the greatest contact surface area.
LCOs that involve wedge resection as well as lateralization were able to achieve the greatest correction of hindfoot varus.
For the surgical treatment of cavovarus foot deformities, osteotomies with wedge resection in addition to lateralization enable more powerful correction.
很少有作者直接比较过多种类型的跟骨外侧移位截骨术（LCO）在矫正畸形方面的能力。本研究旨在使用内翻后足的数字模型，比较 4 种不同的 LCO 在矫正畸形和需要的跟骨结节外侧化程度方面的差异。作者假设涉及楔形切除的截骨术将实现更大的矫正效果，同时外侧化程度更小。
对一名患有内翻后足畸形的患者进行负重 CT 扫描，以构建保留负重对线的后足三维数字模型。对四种不同的 LCO 进行建模：标准斜行截骨术、Dwyer 截骨术、改良 Dwyer 截骨术，除楔形切除外还包括外侧化、Malerba Z 型截骨术，同时进行楔形切除和外侧化。对每种截骨术类型进行增量矫正，并通过垂直后足角和测量跟骨最下侧的外侧平移来评估矫正量。还测量了跟骨长度和截骨接触面积。
改良 Dwyer 截骨术导致垂直后足角和外侧平移的改善最大，其次是 Malerba 截骨术。标准和 Malerba 截骨术允许最大程度地保留跟骨长度；Malerba 和 Dwyer 截骨术具有最大的接触面积。
涉及楔形切除和外侧化的 LCO 能够实现后足内翻畸形的最大矫正。
对于 cavovarus 足畸形的手术治疗，楔形切除加外侧化的截骨术可以实现更强大的矫正。
