Tonogai Ichiro, Sairyo Koichi
Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
Int J Surg Case Rep. 2021 Dec;89:106624. doi: 10.1016/j.ijscr.2021.106624. Epub 2021 Nov 25.
There are no reports on one-stage corrective tibial opening wedge osteotomy and arthrodesis for osteoarthritis of the ankle and tibial malalignment after distal tibial osteotomy.
The patient was a 70-year-old woman who presented with complaints of ankle pain and lower limb deformity after tibial osteotomy performed for ankle arthritis 17-18 years earlier. Clinical examination revealed marked swelling around the ankle joint and pain and tenderness at the joint line. Imaging showed tibial malalignment and severe osteoarthritic changes in the ankle. The patient had valgus deformity of 21° and recurvatum deformity of 4°. In two months, she admitted to Department of Orthopedics at Tokushima University Hospital in Japan and we performed one-stage corrective tibial opening wedge osteotomy and ankle arthrodesis with an anterolateral plate through a lateral longitudinal incision. After removal of the previous implants, the remaining articular cartilage and osteophytes were removed from the tibial and talar surfaces. After debridement of the talar trochlea and tibial plateau, the center of rotation and angular deformity of the tibia was cut transversely and a 1-cm bone graft obtained from the removed fibula was inserted into the osteotomy site, which decreased the tibial malalignment. An anterolateral locking plate was inserted over the anterior and lateral sides of the tibia, and the ankle was fused using 2 cannulated screws.
The patient wore an above-knee splint for 6 weeks to avoid weight-bearing followed by gradual weightbearing with a brace thereafter. Osseous fusion was achieved after about 3.5 months. Radiographs obtained at the 2-year follow-up visit showed complete union of the tibia and talus. Full correction of valgus and recurvatum deformity was achieved, and the patient was able to perform daily activities with almost no pain.
We reported a rare case of ankle osteoarthritis and tibial malalignment that was successfully treated with one-stage corrective tibial opening wedge osteotomy and ankle arthrodesis using an anterolateral plate via a transfibular approach.
目前尚无关于一期矫正性胫骨开放楔形截骨术联合踝关节融合术治疗踝关节骨关节炎及胫骨截骨术后胫骨畸形的报道。
该患者为一名70岁女性，17 - 18年前因踝关节关节炎行胫骨截骨术后出现踝关节疼痛及下肢畸形。临床检查发现踝关节周围明显肿胀，关节线处疼痛及压痛。影像学检查显示胫骨畸形及踝关节严重骨关节炎改变。患者存在21°外翻畸形及4°膝反屈畸形。两个月后，她入住日本德岛大学医院骨科，我们通过外侧纵行切口，采用前外侧钢板行一期矫正性胫骨开放楔形截骨术及踝关节融合术。取出先前植入物后，从胫骨和距骨表面清除剩余的关节软骨和骨赘。清理距骨滑车和胫骨平台后，横向截断胫骨的旋转中心和角畸形部位，将取自切除腓骨的1厘米骨块插入截骨部位，从而减少胫骨畸形。在胫骨前外侧置入一块前外侧锁定钢板，并用2枚空心螺钉固定踝关节。
患者佩戴膝上支具6周以避免负重，之后逐渐使用支具负重。约3.5个月后实现骨融合。2年随访时的X线片显示胫骨和距骨完全愈合。外翻和膝反屈畸形得到完全矫正，患者能够几乎无痛地进行日常活动。
我们报道了一例罕见的踝关节骨关节炎及胫骨畸形病例，通过经腓骨入路采用前外侧钢板行一期矫正性胫骨开放楔形截骨术及踝关节融合术成功治疗。
