Mortimer J Alexandra, Bouchard Maryse, Acosta Anna, Mosca Vincent
University of Saskatchewan, Saskatoon, Saskatchewan, Canada (JAM).
The Hospital for Sick Children, Toronto, Ontario, Canada (MB).
Foot Ankle Spec. 2020 Jun;13(3):250-257. doi: 10.1177/1938640019868061. Epub 2019 Sep 15.
The "foot-CORA" (center of rotation of angulation) method confirms the medial cuneiform as the site of deformity in most forefoot/midfoot deformities and is therefore the ideal location to correct those deformities. It has been consistently observed intraoperatively by the senior author that there is a secondary, unintentional deformity created in the transverse plane when dorsiflexion and plantar flexion osteotomies of the medial cuneiform are performed to correct pronation and supination forefoot deformities, respectively. These effects may not be desirable. This biplanar effect of medial cuneiform osteotomies has been observed but not studied. The purpose of this study was to perform the 4 commonly used medial cuneiform osteotomy techniques on cadaveric feet to demonstrate their biplanar effects. Four formaldehyde preserved cadaveric feet were used to perform 4 techniques of medial cuneiform osteotomy: dorsiflexion plantar-based opening wedge, plantar flexion dorsal-based opening wedge, dorsiflexion dorsal-based closing wedge, and plantar flexion plantar-based closing wedge. Photographs and fluoroscopy were used to assess the angular changes in the sagittal and transverse planes. Angular measurements were made using OsiriX software on fluoroscopic images. The medial cuneiform opening wedge osteotomies produced midfoot abduction in addition to the desired dorsiflexion and plantar flexion. The medial cuneiform closing wedge osteotomies produced midfoot adduction in addition to the desired dorsiflexion and plantar flexion. We confirm that intentional sagittal uniplanar osteotomies of the medial cuneiform create obligate biplanar effects. This is likely a result of tethering by ligaments and the joint capsules on the lateral border of the medial cuneiform. The obligate transverse plane effect can be used to one's advantage or result in an undesired effect if not considered during surgical planning and execution. We propose a simple treatment algorithm for selecting the appropriate medial cuneiform osteotomy for forefoot/midfoot deformities. Level V.
“足部CORA”（成角旋转中心）方法证实，在大多数前足/中足畸形中，内侧楔骨是畸形部位，因此是矫正这些畸形的理想位置。资深作者在术中一直观察到，在内侧楔骨进行背屈和跖屈截骨术以分别矫正前足内旋和外旋畸形时，会在横平面产生继发性无意畸形。这些影响可能并不理想。内侧楔骨截骨术的这种双平面效应已被观察到，但尚未进行研究。本研究的目的是在尸体足部上实施4种常用的内侧楔骨截骨技术，以展示其双平面效应。使用4只经甲醛保存的尸体足部实施4种内侧楔骨截骨技术：背屈跖侧基底开放楔形截骨、跖屈背侧基底开放楔形截骨、背屈背侧基底闭合楔形截骨和跖屈跖侧基底闭合楔形截骨。通过照片和荧光透视来评估矢状面和横平面的角度变化。使用OsiriX软件在荧光透视图像上进行角度测量。内侧楔骨开放楔形截骨术除了产生所需的背屈和跖屈外，还导致中足外展。内侧楔骨闭合楔形截骨术除了产生所需的背屈和跖屈外，还导致中足内收。我们证实，内侧楔骨的有意矢状面单平面截骨会产生必然的双平面效应。这可能是由于内侧楔骨外侧边缘的韧带和关节囊束缚所致。如果在手术规划和实施过程中未考虑到，这种必然的横平面效应可能会带来有利影响，也可能导致不良后果。我们提出了一种简单的治疗算法，用于为前足/中足畸形选择合适的内侧楔骨截骨术。V级。
