Park Chul Hyun, Park Jeong-Jin, Woo In-Ha
Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea.
Korea Armed Forces Athletic Corps, Mungyeong 36931, Republic of Korea.
J Clin Med. 2024 Aug 15;13(16):4803. doi: 10.3390/jcm13164803.
: Recent studies utilizing weight-bearing computed tomography have identified abnormal internal rotation of the talus in advanced varus ankle arthritis (VAA) with a large talar tilt (TT), influenced by the posterior tibial tendon (PTT). This study aimed to evaluate the clinical and radiographic results of supramalleolar osteotomy (SMO) combined with PTT release and lateral ligament augmentation for VAA with a large TT. : From January 2015 to September 2018, 15 patients with VAA and a large TT (greater than 5°) underwent SMO combined with PTT release. Clinical results, including visual analog scale (VAS) for pain, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and ankle osteoarthritis scale (AOS), were assessed. Radiographic results were assessed with various parameters, including medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), talar tilt (TT), talus center migration (TCM), Meary angle, hindfoot alignment angle (HAA), and hindfoot moment arm (HMA) on foot and ankle weight-bearing radiographs. Clinical and radiographic results were evaluated preoperatively and at the last follow-up. : VAS, AOFAS ankle-hindfoot score, and AOS improved significantly from 7.5, 54.4, and 72.6 preoperatively to 3.1, 82.5, and 34.5 postoperatively, respectively. All radiographic parameters exhibited significant changes postoperatively, with the exception of the Meary angle, which demonstrated no significant change. Four patients exhibited improvement in radiographic stage postoperatively; however, average radiographic stage did not significantly improve postoperatively in all patients. One patient progressed to end-stage arthritis postoperatively, necessitating additional ankle arthrodesis. : In conclusion, lengthening and lateral ligament augmentation combined with bony realignment procedures may be a reasonable option for treating VAA with a large TT greater that 5°.
近期利用负重计算机断层扫描的研究发现，在伴有大角度距骨倾斜（TT）的晚期内翻踝关节关节炎（VAA）中，距骨存在异常内旋，这受到胫后肌腱（PTT）的影响。本研究旨在评估联合PTT松解及外侧韧带增强的 supramalleolar截骨术（SMO）治疗伴有大角度TT的VAA的临床和影像学结果。
2015年1月至2018年9月，15例伴有大角度TT（大于5°）的VAA患者接受了SMO联合PTT松解术。评估了临床结果，包括疼痛视觉模拟量表（VAS）、美国矫形足踝协会（AOFAS）踝后足评分以及踝关节骨关节炎量表（AOS）。通过各种参数评估影像学结果，包括足踝负重X线片上的胫距关节内侧远端角（MDTA）、胫距关节前侧远端角（ADTA）、距骨倾斜（TT）、距骨中心移位（TCM）、Meary角、后足对线角（HAA）以及后足力矩臂（HMA）。术前及末次随访时评估临床和影像学结果。
VAS、AOFAS踝后足评分及AOS分别从术前的7.5、54.4和72.6显著改善至术后的3.1、82.5和34.5。除Meary角外，所有影像学参数术后均有显著变化，Meary角无显著变化。4例患者术后影像学分期改善；然而，所有患者术后平均影像学分期未显著改善。1例患者术后进展为终末期关节炎，需要额外进行踝关节融合术。
总之，延长及外侧韧带增强联合骨重建手术可能是治疗大于5°大角度TT的VAA的合理选择。
