Operative Orthopadie und Traumatologie · 2008
[Osteotomies in varus malalignment of the ankle].
Клиническое исследованиеАннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Knupp Markus, Pagenstert Geert, Valderrabano Victor, Hintermann Beat
Аннотация
OBJECTIVE: Joint-preserving osteotomies in patients with symptomatic varus malalignment of the ankle. Osseous procedures together with soft-tissue rebalancing are performed at the level of the distal tibia/fibula or calcaneus. Realignment of the joint line will subsequently reduce intraarticular forces at the ankle and thereby slow down the degenerative process.
INDICATIONS: Varus malalignment of the ankle with remaining cartilage in the tibiotalar joint.
CONTRAINDICATIONS: Severe neurovascular deficiencies. Severe instability of the hindfoot. Severe cartilage lesions of the entire ankle (grade 3-4 according to Outerbridge).
SURGICAL TECHNIQUE: Varus deformities of the distal tibia: medial opening-wedge osteotomy or lateral closing-wedge osteotomy. The lateral closing procedure requires an osteotomy of the fibula. Varus deformity of the hindfoot: valgization by lateral closing- wedge osteotomy of the calcaneus and lateral shift of the calcaneal tuberosity, i.e., Z-shaped osteotomy. Additional procedures at the first metatarsal and softtissue procedures must be considered in all these patients.
POSTOPERATIVE MANAGEMENT: Immobilization in a non-weight-bearing cast for 6-8 weeks. Thereafter, increase in weight bearing as tolerated. Physiotherapy for muscular strengthening and restoration of gait pattern.
RESULTS: Twelve patients with an osteotomy of the distal tibia presented with a significant reduction of pain on a visual analog scale (p = 0.0001) and an increased range of motion of 33 degrees (5-55 degrees ) preoperatively compared to 39 degrees (25-50 degrees ) postoperatively. Radiologic assessment also revealed an improvement of preexisting arthritic signs. All 18 patients treated with a Z-shaped calcaneal osteotomy reported pain relief with osseous consolidation after 6 months.
INDICATIONS: Varus malalignment of the ankle with remaining cartilage in the tibiotalar joint.
CONTRAINDICATIONS: Severe neurovascular deficiencies. Severe instability of the hindfoot. Severe cartilage lesions of the entire ankle (grade 3-4 according to Outerbridge).
SURGICAL TECHNIQUE: Varus deformities of the distal tibia: medial opening-wedge osteotomy or lateral closing-wedge osteotomy. The lateral closing procedure requires an osteotomy of the fibula. Varus deformity of the hindfoot: valgization by lateral closing- wedge osteotomy of the calcaneus and lateral shift of the calcaneal tuberosity, i.e., Z-shaped osteotomy. Additional procedures at the first metatarsal and softtissue procedures must be considered in all these patients.
POSTOPERATIVE MANAGEMENT: Immobilization in a non-weight-bearing cast for 6-8 weeks. Thereafter, increase in weight bearing as tolerated. Physiotherapy for muscular strengthening and restoration of gait pattern.
RESULTS: Twelve patients with an osteotomy of the distal tibia presented with a significant reduction of pain on a visual analog scale (p = 0.0001) and an increased range of motion of 33 degrees (5-55 degrees ) preoperatively compared to 39 degrees (25-50 degrees ) postoperatively. Radiologic assessment also revealed an improvement of preexisting arthritic signs. All 18 patients treated with a Z-shaped calcaneal osteotomy reported pain relief with osseous consolidation after 6 months.