Open-wedge high tibial osteotomy with special medial plate fixator

被引：108

作者：

Lobenhoffer P. ^{[1
,2
]}

Agneskirchner J. ^{[1
]}

Zoch W. ^{[1
]}

机构：

[1] Klin. fur Wiederherstellungschir., Henriettenstiftung, Hannover

[2] Klin. fur Wiederherstellungschir., Henriettenstiftung, 30171 Hannover

来源：

Der Orthopäde | 2004年 / 33卷 / 2期

关键词：

High tibial osteotomy; Open-wedge osteotomy; Plate fixator; TomoFix; Unicompartmental osteoarthritis; Varus malalignment;

D O I：

10.1007/s00132-003-0593-0

中图分类号：

学科分类号：

摘要：

High tibial osteotomy (HTO) is an established technique for the treatment of the symptomatic varus malaligned knee. Correction is usually acheived by closed wedge osteotomy from a lateral exposure. This procedure has a certain risk potential regarding peroneal nerve injuries, instability of the osteotomy and secondary loss of correction. We present four technical modifications of HTO which improve safety and reproducability of this operation. 1) Open wedge osteotomy from a medial exposure avoids lateral muscle detachment, dissection of the peroneal nerve, proximal fibula osteotomy and leg shortening. Only one osteotomy needs to be performed and the correction can be adapted intraoperatively. 2) A biplanar osteotomy provides improved rotational stability of the osteotomy and creates an anterior buttress against sagittal tilting. 3) An incomplete osteotomy with plastic deformation of the intact lateral bone bridge avoids fractures of the lateral cortex and instabilities and promotes bone healing. 4) Rigid fixation with a medial plate-fixator (Tomofix®) allows for early mobilsation and avoids loss-of-correction. 262 patients were consecutively operated using the described modified technique until now. No loss-of-correction occurred in this group, two patients with delayed healing received secondary cancellous bone grafts.

引用

页码：153 / 160

页数：7

共 20 条

[1]

Aydogdu S., Cullu E., Arac N., Varolgunes N., Sur H., Prolonged peroneal nerve dysfunction after high tibial osteotomy: Pre- and postoperative electrophysiological study, Knee Surg Sports Traumatol Arthrosc, 8, pp. 305-308, (2000)

[2]

Coventry M.B., Osteotomy about the knee for degenerative and rheumatoid arthritis, J Bone Joint Surg Am, 55, pp. 23-48, (1973)

[3]

Coventry M.B., Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long term results, Orthop Clin North Am, 10, pp. 191-210, (1979)

[4]

Coventry M.B., Proximal tibial osteotomy, Orthop Rev, 17, pp. 456-458, (1988)

[5]

De Simoni C., Staubli A., Neue Fixationstechniken für mediale open-wedge Osteotomien der proximalen Tibia, Schweiz Med Wochenschr, 119, (2000)

[6]

Dejour H., Bonnin M., Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared, J Bone Joint Surg Br, 76, pp. 745-749, (1994)

[7]

Fujisawa Y., Masuhara K., Shiomi S., The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints, Orthop Clin North Am, 10, pp. 585-608, (1979)

[8]

Hassenpflug J., Von Haugwitz A., Hahne H.J., Long-term results of tibial head osteotomy, Z Orthop Ihre Grenzgeb, 136, pp. 154-161, (1998)

[9]

Insall J.N., Joseph D.M., Msika C., High tibial osteotomy for varus gonarthrosis. A long-term follow-up study, J Bone Joint Surg Am, 66, pp. 1040-1048, (1984)

[10]

Ivarsson I., Myrnerts R., Gillquist J., High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up, J Bone Joint Surg Br, 72, pp. 238-244, (1990)

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