Igarashi Kentaro, Yamamoto Norio, Hayashi Katsuhiro, Matsubara Hidenori, Takeuchi Akihiko, Miwa Shinji, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.
Arthrosc Tech. 2020 Jul 28;9(8):e1079-e1086. doi: 10.1016/j.eats.2020.04.004. eCollection 2020 Aug.
High tibial osteotomy for medial-compartment knee osteoarthritis (OA) is an established biological knee reconstruction surgical procedure. In open- and closed-wedge high tibial osteotomy, the angulation correction axes are away from the center of rotation and angulation. This results in translation deformity, which alters the orientation of the adjacent joint and the length of the limb. In the present study, we combined the distal tibial tuberosity focal dome osteotomy centered on the center of rotation and angulation with the longitudinal condylar osteotomy (focal dome condylar osteotomy) for knee OA. The advantages of this procedure are as follows: physiological orientation of adjacent joint is achieved; limb length is maintained; joint stabilization in the coronal plane is achieved; patella infra is prevented; sufficient bone contact between the medial and posterior cortex is achieved; early weight-bearing walking is possible; and fibular osteotomy is not required. This study describes the details of the surgical procedure, including our compass cutter for accurate dome osteotomy and the postoperative rehabilitation program for patients with knee OA and moderate-to-severe varus deformity.
用于治疗内侧间室膝关节骨关节炎（OA）的高位胫骨截骨术是一种成熟的膝关节生物重建手术。在开放式和闭合式楔形高位胫骨截骨术中，角度矫正轴远离旋转中心和角度。这会导致平移畸形，从而改变相邻关节的方向和肢体长度。在本研究中，我们将以旋转和角度中心为中心的胫骨远端结节局灶性穹窿截骨术与用于膝关节OA的纵髁截骨术（局灶性穹窿髁截骨术）相结合。该手术的优点如下：实现相邻关节的生理方向；保持肢体长度；在冠状面实现关节稳定；防止髌骨低位；在内侧和后皮质之间实现足够的骨接触；早期负重行走成为可能；并且不需要腓骨截骨术。本研究描述了手术过程的细节，包括我们用于精确穹窿截骨术的罗盘切割器以及针对膝关节OA和中度至重度内翻畸形患者的术后康复计划。
