Kuwashima Umito, Yonekura Akihiko, Itoh Masafumi, Itou Junya, Okazaki Ken
Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 7-1 Sakamoto, Nagasaki, 852-8501, Japan.
J Exp Orthop. 2020 May 13;7(1):30. doi: 10.1186/s40634-020-00247-5.
To describe the indications for, and surgical technique of, tibial condylar valgus osteotomy (TCVO).
TCVO is commonly performed in patients with middle-to-end-stage medial unicompartmental osteoarthritis. Among the most important TCVO indication criteria are the types of tibial plateau shape. The convex-type (also called "pagoda-type"), with over a 5° joint line convergence angle on the standing X-ray, meets the indication criteria for TCVO.
An L-shaped osteotomy is performed from the medial side of the proximal tibia to the lateral beak of the intercondylar eminence. The apex of the L-shaped osteotomy line is on the medial border of the patellar tendon insertion. Surgeons should note the direction of the chisel (during the osteotomy) to the intercondylar eminence following fluoroscopic guidance. The posterior cortical bone is cut under a lateral view observation, and the crossed-leg position is adopted to prevent injury to the popliteal blood vessels. The spreader should be positioned at the posterior cortical bone to avoid increasing the tibial slope. The locking plate reliably stabilizes the osteotomy and helps shorten the period of postoperative rehabilitation.
TCVO adjusts varus deformity alongside joint congruity. Accurate identification of indications and a detailed surgical plan would ensure effective correction and proper alignment. Additional osteotomies are recommended in case of under-correction of the varus limb deformity. TCVO is an effective intervention in patients with advanced knee osteoarthritis and lateral joint laxity with the pagoda-type tibial plateau shape.
描述胫骨髁外翻截骨术（TCVO）的适应症及手术技术。
TCVO常用于中晚期内侧单髁骨关节炎患者。胫骨平台形状类型是最重要的TCVO适应症标准之一。站立位X线片上关节线汇聚角超过5°的凸型（也称为“宝塔型”）符合TCVO的适应症标准。
从胫骨近端内侧向髁间隆起外侧喙进行L形截骨。L形截骨线的顶点位于髌腱止点的内侧缘。手术医生应在透视引导下注意截骨时凿子指向髁间隆起的方向。在侧位观察下切断后皮质骨，并采用交叉腿位以防止损伤腘血管。撑开器应放置在后皮质骨处，以避免增加胫骨坡度。锁定钢板能可靠地稳定截骨，并有助于缩短术后康复时间。
TCVO在矫正内翻畸形的同时可调整关节一致性。准确识别适应症并制定详细的手术计划可确保有效矫正和正确对线。如果内翻肢体畸形矫正不足，建议进行额外截骨。对于晚期膝骨关节炎且伴有外侧关节松弛及宝塔型胫骨平台形状的患者，TCVO是一种有效的干预措施。
