Mathieu Julie, Gatti Mathilde, Dagneaux Louis
Service de Chirurgie Orthopédique et Traumatologie, CHU de Montpellier, 371 Avenue Gaston Giraud, 34295 Montpellier Cedex 05, France; Laboratoire de Mécanique et Génie Civil, LMGC, Université de Montpellier, 860 Rue de Saint-Priest, 34090 Montpellier, France.
Service de Chirurgie Orthopédique et Traumatologie, CHU de Montpellier, 371 Avenue Gaston Giraud, 34295 Montpellier Cedex 05, France.
Orthop Traumatol Surg Res. 2025 Feb;111(1S):104071. doi: 10.1016/j.otsr.2024.104071. Epub 2024 Nov 26.
Supramalleolar osteotomy (SMO) aims to correct extra-articular deformities of the distal lower leg. There are several indications, the most common being varus osteoarthritis of the ankle. The rationale in this indication is to modify talocrural stress and pressure distribution by reorienting the limb axis. Preoperative planning is essential to optimize functional outcome, limiting the risk of under- or over-correction. Several SMO procedures have been described, and are preferably performed at the deformity site or center of rotation and angulation (CORA). They aim to restore talocrural joint-line anatomy and correct talar tilt while conserving physiological hindfoot valgus. Techniques use K-wires as cut guides. 3D imaging and patient-specific instrumentation now play key roles in this surgery, which is difficult both to plan and to execute. The present study addresses the following questions: What are the indications and contraindications? What are the technical principles? What preoperative work-up is required for planning and execution? What are the technical particularities? And what contribution can new technologies make? LEVEL OF EVIDENCE: V.
踝关节上截骨术（SMO）旨在矫正小腿远端的关节外畸形。其适应证有多种，最常见的是踝关节内翻性骨关节炎。该适应证的理论依据是通过重新调整肢体轴线来改变距小腿关节的应力和压力分布。术前规划对于优化功能结果、限制矫正不足或过度矫正的风险至关重要。已经描述了几种SMO手术，最好在畸形部位或旋转与成角中心（CORA）进行。这些手术旨在恢复距小腿关节线解剖结构并矫正距骨倾斜，同时保留生理性后足外翻。技术上使用克氏针作为截骨导向。3D成像和患者特异性器械现在在这项手术中发挥着关键作用，该手术在规划和实施上都很困难。本研究探讨以下问题：适应证和禁忌证有哪些？技术原则是什么？规划和实施手术需要哪些术前检查？技术特点是什么？新技术能做出什么贡献？证据级别：V级。
