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双平面外侧半楔形截骨术治疗重度胫骨内翻畸形

Biplanar Lateral Hemi-Wedge Osteotomy for the Correction of Severe Tibial Varus Deformity.

作者信息

Petersen Wolf, Al Mustafa Hassan, Häner Martin

机构信息

Department for Orthopedics and Trauma Surgery, Martin Luther Hospital Berlin, Berlin, Germany.

出版信息

Arthrosc Tech. 2024 Sep 6;13(12):103211. doi: 10.1016/j.eats.2024.103211. eCollection 2024 Dec.

DOI:10.1016/j.eats.2024.103211
PMID:39780900
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11704884/
Abstract

Indication for this hemi-wedge high tibial osteotomy is the combination of medial osteoarthritis or cartilage damage, varus deformity of >10°, and medial proximal tibial angle of <80°. The proximal lateral tibia is exposed via a skin incision of approximately 10 cm length between the tibial tuberosity and the head of the fibula. After detachment of the anterior tibial muscle, a first oblique guidewire marks the main osteotomy plane and a second guidewire marks the hemi-wedge. Then, the osteotomy is performed along the guidewires with an oscillating saw and the laterally based wedge is removed. After percutaneous needling of the medial collateral ligament with a cannula, the lateral gap is closed and stabilized with an angular-stable plate. The rehabilitation protocol includes partial weight-bearing with 10 kg for 6 weeks and free range of motion.

摘要

这种半楔形高位胫骨截骨术的适应症为内侧骨关节炎或软骨损伤、内翻畸形大于10°以及胫骨近端内侧角小于80°。通过在胫骨结节与腓骨头之间做一个大约10厘米长的皮肤切口来暴露胫骨近端外侧。在前胫骨肌分离后，第一根斜导丝标记主要截骨平面，第二根导丝标记半楔形。然后，沿导丝用摆动锯进行截骨，并去除外侧基底的楔形骨块。在用套管经皮穿刺内侧副韧带后，闭合外侧间隙并用角稳定钢板进行固定。康复方案包括6周内部分负重10公斤以及关节活动度自由。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/31b60749b527/gr12.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/bab30f6457d6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/0b6d4a919b7a/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/4f7f69d33cfc/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/85655a006ed6/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/a6f51ad8f0a5/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/bb450f84168f/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/c27866795c3d/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/9a88871fff5b/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/e9d3121a9726/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/23053cadf085/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/31b60749b527/gr12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/2ee5ec50359c/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/bab30f6457d6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/0b6d4a919b7a/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/4f7f69d33cfc/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/85655a006ed6/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/a6f51ad8f0a5/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/bb450f84168f/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/c27866795c3d/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/9a88871fff5b/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/e9d3121a9726/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/23053cadf085/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32a7/11704884/31b60749b527/gr12.jpg

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Editorial Commentary: High Tibial Osteotomy and Distal Femoral Osteotomy Address Biologics and Biomechanics.编辑评论：高位胫骨截骨术和股骨远端截骨术涉及生物制剂和生物力学。
Arthroscopy. 2024 Mar;40(3):844-845. doi: 10.1016/j.arthro.2023.08.009. Epub 2024 Jan 12.
2
Implant Removal After Medial Opening Wedge High Tibial Osteotomy Provides Implant-Related Pain Relief and Functional Improvement.内侧开口楔形高位胫骨截骨术后取出植入物可缓解与植入物相关的疼痛并改善功能。
Arthroscopy. 2024 Jun;40(6):1837-1844. doi: 10.1016/j.arthro.2023.10.044. Epub 2023 Nov 8.
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A Supratuberosity Anterior Closing-Wedge Proximal Tibial Osteotomy Increases Patellar Height: A Simulated Time Zero Uniplanar Radiographic Study.
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Arthroscopy. 2024 May;40(5):1544-1554.e1. doi: 10.1016/j.arthro.2023.09.002. Epub 2023 Sep 22.
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Knee Osteotomy Decreases Joint Inflammation Based on Synovial Histology and Synovial Fluid Analysis.膝关节截骨术可通过滑膜组织学和滑液分析减轻关节炎症。
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