Bugbee William D, Brage Michael E
Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, La Jolla, CA 92037. E-mail address:
Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Harborview Medical Center, 3325 Ninth Avenue, Box 359799, Seattle, WA 98104.
JBJS Essent Surg Tech. 2014 Feb 12;4(1):e3. doi: 10.2106/JBJS.ST.M.00038. eCollection 2014 Mar.
Bipolar osteochondral allografting is a technically complex procedure envisioned as an alternative to arthrodesis or arthroplasty in carefully selected young patients with advanced tibiotalar arthritis, usually as a result of trauma.
STEP 1 PREOPERATIVE PLANNING: Confirm that the grafts are not damaged and that the side (left or right) and size (not too small) are properly matched to the donor.
STEP 2 PLACEMENT OF THE EXTERNAL FIXATOR: Place an external fixator across the ankle joint using fluoroscopy and distract the ankle prior to incision.
STEP 3 ANTERIOR APPROACH TO THE ANKLE: Perform a standard anterior approach to the ankle joint.
STEP 4 POSITIONING OF THE CUTTING JIG: Mount the jig on the ankle and confirm the cutting block position both visually and fluoroscopically.
STEP 5 BONE RESECTION: Using a reciprocating saw and careful technique to protect the tendons and neurovascular structures, perform osseous resection of the distal part of the tibia and the talar dome.
STEP 6 PREPARATION OF THE ALLOGRAFT: Prepare the tibial and talar allografts from the donor tissue to match the resection gap created in Step 5.
STEP 7 INSERTION AND FIXATION OF THE ALLOGRAFT: Insert and fix the allograft construct and remove the external fixator.
STEP 8 REHABILITATION: Postoperative care is straightforward, including initial immobilization and a three-month period of non-weight-bearing.
In our recent clinical study, we used our clinical outcomes database to identify eighty-four consecutive patients (eighty-eight ankles) who underwent bipolar osteochondral allograft transplantation of the tibiotalar joint, had surgery in 1999 or later, and had not had a previous arthroplasty or osteochondral allograft transplantation involving the tibial plafond and/or talus.IndicationsContraindicationsPitfalls & Challenges.
双极骨软骨异体移植是一项技术复杂的手术，旨在为精心挑选的患有晚期胫距关节炎（通常由创伤引起）的年轻患者提供关节融合术或关节置换术的替代方案。
步骤1术前规划：确认移植物未受损，且其侧面（左或右）和尺寸（不过小）与供体匹配得当。
步骤2外固定器的放置：使用荧光透视法在踝关节上放置外固定器，并在切开前撑开踝关节。
步骤3踝关节前路入路：进行踝关节标准前路入路。
步骤4切割夹具的定位：将夹具安装在踝关节上，通过视觉和荧光透视法确认切割块的位置。
步骤5骨切除：使用往复锯并采用小心的技术以保护肌腱和神经血管结构，对胫骨远端和距骨穹窿进行骨切除。
步骤6异体移植物的制备：从供体组织制备胫骨和距骨异体移植物，以匹配步骤5中形成的切除间隙。
步骤7异体移植物的插入与固定：插入并固定异体移植物结构，然后拆除外固定器。
步骤8康复：术后护理简单直接，包括初期固定和三个月的非负重期。
在我们最近的临床研究中，我们使用临床结果数据库识别了连续84例患者（88个踝关节），这些患者接受了胫距关节双极骨软骨异体移植，于1999年或之后进行手术，且此前未进行过涉及胫骨平台和/或距骨的关节置换术或骨软骨异体移植。适应症、禁忌症、陷阱与挑战。
