Deshpande Shantanu S
Deenanath Mangeshkar Hospital, Department of Joint Replacement, Kothrud, Pune, India.
J Clin Orthop Trauma. 2024 Jun 28;54:102474. doi: 10.1016/j.jcot.2024.102474. eCollection 2024 Jul.
The surgical execution of osteotomy requires precision in measuring the wedge angle. The pre-operative planning methods are plenty and so are few devices for high tibial osteotomy. But struggle happens for those bony areas other than proximal tibia where alignment correction is needed. The new device is proposed to address this surgical problem. The ease of measuring angle for bony wedge angle, in any bone, independent of its width and in any plane, is the question being solved with the proposed devices.
Two jig instruments have been shown in the study. First one the curved with direct angle measuring marking in degrees on the body. K wire is accepted through the tower exactly showing the desired angle. The second jig instrument is flat design with marking in millimeters. This device works on trigonometric principle of sum of angles of any triangle is equal to 180°. The jig can be removed leaving the k wires in place to complete the final osteotomy once confirmed.
It's a pre-clinical stage study. The saw bone models show encouraging measurements and perfect execution of angle at the osteotomy site.
HTO has been researched a lot with many options of surgical devices. The criticism of using known devices is the variable accuracy, especially for the smaller width of tibial metaphysis. One major limitation of these available instruments is they can be used only for proximal tibial metaphysis. For any other surgical sites like distal femur, distal tibia, distal humerus or tibial slope correction neither these HTO jigs will work nor there is any available universal instrument as such. The common misconception of one degree equal to 1 mm does not stand true at all bony sites. Hence there was a need to solve this problem with universal jig. I have designed two new devices which are currently at pre-clinical stage. The curve device has limitations which get corrected in straight device. The philosophy changes from one direct measurement with two tips of wires forming the angle in a curved device to indirect measurement by simple trigonometric calculation in a straight device. The proposed new device would work in any bone, for any trapezoidal wedge shape osteotomy using simple user-friendly k wires.
截骨术的手术操作需要精确测量楔形角度。术前规划方法众多，但用于高位胫骨截骨术的设备却很少。对于需要进行对线矫正的胫骨近端以外的其他骨区域，手术操作存在困难。为此提出了一种新设备来解决这一手术问题。所提出的设备旨在解决在任何骨中测量骨楔形角度的问题，该角度测量不受骨宽度影响，且可在任何平面进行。
本研究展示了两种夹具器械。第一种是弯曲的，其主体上有以度为单位的直接角度测量标记。克氏针可穿过塔架，精确显示所需角度。第二种夹具器械是扁平设计，以毫米为单位进行标记。该设备基于任何三角形内角和等于180°的三角原理工作。确认角度后，可移除夹具，保留克氏针以完成最终截骨术。
这是一项临床前阶段的研究。锯骨模型显示测量结果令人鼓舞，截骨部位的角度执行完美。
高位胫骨截骨术已经有很多研究，手术设备也有多种选择。对现有设备的批评在于其精度可变，特别是对于胫骨干骺端较窄的宽度。这些现有器械的一个主要局限性是它们仅可用于胫骨近端干骺端。对于任何其他手术部位，如股骨远端、胫骨远端、肱骨远端或胫骨斜率矫正，这些高位胫骨截骨术夹具均无法使用，也没有此类通用器械。一度等于1毫米的普遍误解在所有骨部位根本不成立。因此，需要用通用夹具解决这个问题。我设计了两种新设备，目前处于临床前阶段。弯曲设备存在局限性，而直线设备对其进行了改进。理念从弯曲设备中用两根钢丝尖端形成角度的直接测量转变为直线设备中通过简单三角计算的间接测量。所提出的新设备将适用于任何骨，使用简单易用的克氏针对任何梯形楔形截骨术均可发挥作用。
