Choi Jun Young, Suh Jin Soo
Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Gyeonggi-do, Republic of Korea.
J Clin Med. 2025 Apr 17;14(8):2781. doi: 10.3390/jcm14082781.
Numerous studies exist on medial opening wedge supramalleolar osteotomy (SMO), ever since its introduction by Takakura et al., as a joint-preserving surgical option for treating varus ankle osteoarthritis (OA). Although SMO can induce lateral translation of the talus-which is medially translated in varus ankle OA-it has only minimal effects on the correction of the varus tilt of the talus. Particularly, SMO alone does not effectively neutralize the talar position. The primary reason for this limitation is that varus tilting of the talus is not merely a two-dimensional deformity in the coronal plane, but rather a three-dimensional deformity involving internal rotation and anterior subluxation. Therefore, this study aimed to explore the key considerations for achieving effective correction of varus talar tilt in joint-preserving surgery for treating degenerative varus ankle OA with large talar tilting. Further, we have discussed the relevant studies and included the lessons learned from our clinical experience, categorizing the key surgical considerations into preoperative, intraoperative, and postoperative phases.
自从高仓等人引入内侧开口楔形距下关节上截骨术（SMO）作为治疗内翻性踝关节骨关节炎（OA）的一种保留关节的手术选择以来，已有大量关于该手术的研究。尽管SMO可以诱导距骨向外移位（在踝关节内翻OA中距骨向内移位），但它对纠正距骨内翻倾斜的作用微乎其微。特别是，单纯的SMO并不能有效地中和距骨位置。造成这种局限性的主要原因是距骨内翻倾斜不仅仅是冠状面的二维畸形，而是一种涉及内旋和前半脱位的三维畸形。因此，本研究旨在探讨在保留关节的手术中有效纠正伴有大角度距骨倾斜的退行性内翻性踝关节OA的距骨内翻倾斜的关键注意事项。此外，我们讨论了相关研究，并纳入了我们临床经验中的经验教训，将关键手术注意事项分为术前、术中和术后阶段。
