Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea.
Foot Ankle Int. 2020 Sep;41(9):1122-1132. doi: 10.1177/1071100720938801. Epub 2020 Jul 31.
Low tibial valgization osteotomy with medial opening wedge (LTO) is generally indicated for ankle arthritis with a small talar tilt (TT). We addressed the following research questions: the efficacy of LTO for more significant varus ankle arthritis, the effect of additional inframalleolar correction followed by LTO, and the preoperative or operation-related factors influencing postoperative TT decrease.
We retrospectively reviewed the radiographic and clinical findings of 31 patients with more significant varus ankle arthritis (≥8 degrees) who underwent LTO or LTO plus inframalleolar correction. We grouped the included patients according to combination with inframalleolar correction and postoperative decreased TT. Furthermore, a binary logistic regression analysis was performed to determine the factors influencing postoperative TT decrease.
Even though the mean TT was unchanged postoperatively (from 12.1 to 9.9 degrees, = .052), clinical parameters were significantly increased. In the group with concomitant inframalleolar correction, we found that TT was more corrected (3.9 vs 1.8 degrees, = .023) with a greater lateralization of the talar center and a greater correction of the hindfoot alignment to valgus. The results of the binary logistic regression analysis showed a significant relationship between postoperative decreased TT and preoperative talar center migration ( = .016), hindfoot alignment angle ( = .033), hindfoot moment arm ( = .041), and hindfoot alignment ratio ( = .016).
LTO in more significant varus ankle arthritis could result in clinical improvement, although TT was not significantly changed. We recommend adding inframalleolar correction after LTO for the patients with more significant varus ankle arthritis.
Level III, comparative series.
胫骨低位内翻截骨伴内侧撑开楔形截骨术（LTO）通常适用于伴有小距骨倾斜（TT）的踝关节关节炎。我们解决了以下研究问题：LTO 治疗更严重的内翻踝关节关节炎的疗效、LTO 后附加距下矫正的效果以及影响术后 TT 减少的术前或手术相关因素。
我们回顾性分析了 31 例接受 LTO 或 LTO 加距下矫正的更严重内翻踝关节关节炎（≥8°）患者的影像学和临床资料。我们根据是否联合距下矫正以及术后 TT 减少的情况对纳入患者进行分组。此外，我们还进行了二项逻辑回归分析，以确定影响术后 TT 减少的因素。
尽管术后 TT 平均值无明显变化（从 12.1°变为 9.9°， =.052），但临床参数显著增加。在联合距下矫正组，我们发现 TT 得到了更多的矫正（3.9°比 1.8°， =.023），距骨中心外侧化和后足对线内翻的矫正程度更大。二项逻辑回归分析的结果显示，术后 TT 减少与术前距骨中心迁移（ =.016）、后足对线角度（ =.033）、后足力矩臂（ =.041）和后足对线比值（ =.016）有显著关系。
对于更严重的内翻踝关节关节炎患者，LTO 可改善临床症状，尽管 TT 无明显变化。我们建议对于更严重的内翻踝关节关节炎患者，在 LTO 后附加距下矫正。
III 级，比较性系列研究。
