The Teramoto distal tibial oblique osteotomy (DTOO): surgical technique and applicability for ankle osteoarthritis with varus deformity.
The Teramoto distal tibial oblique osteotomy (DTOO): surgical technique and applicability for ankle osteoarthritis with varus deformity.
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DOI：
10.1007/s11751-018-0307-0
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发表时间：
2018-04
影响因子：
0.8
通讯作者：
Kinugsa K
中科院分区：
文献类型：
--
作者：
Teramoto T;Harada S;Takaki M;Asahara T;Kato N;Takenaka N;Matsushita T;Makino Y;Tasiro K;Kazutaka O;Nishi Y;Kinugsa K
我们设计了一种内侧关节周围截骨术，即胫骨远端斜截骨术（DTOO），并自1994年以来一直使用该技术治疗与内翻倾斜相关的晚期和晚期踝关节骨关节炎。本报告描述了手术技术及其适用性。DTOO可用于踝关节活动范围至少为10°或更大的内翻踝关节骨关节炎病例。截骨术从近端内侧到远端外侧斜向切割胫骨远端，为开放楔形，旋转中心与胫腓关节中心一致。将椎板撑开器插入截骨术中以打开楔形，直到在X线片上看到距骨体的外侧表面与外踝的内侧关节面接触并一致。可能妨碍这种接触和吻合的常见障碍是腓骨前侧或胫骨外侧的骨刺;这些骨刺需要去除。开放楔形截骨术由Ilizarov外固定器固定或用钢板内固定。从髂嵴取骨移植物并插入开放楔形块中。如果截骨术完成后，踝关节的背屈角度不超过0°，则对跟腱进行Z延长。在踝关节骨关节炎的DTOO中，踝关节的接触面积增加，单位面积的载荷压力减小。此外，随着踝关节榫眼的宽度通过距骨体的重新排列而恢复，踝关节处的不稳定性降低。通过恢复胫骨远端关节面的倾斜度，可以获得额外的改善，因为这可以引导后足外翻并纠正足部对线，从而改善踝关节疼痛。
We have devised a medial peri-articular osteotomy, the distal tibial oblique osteotomy (DTOO), and have used this technique since 1994 for ankle osteoarthritis of advanced and late stages associated with varus inclination. This report describes the surgical technique and its applicability. DTOO can be used for cases of varus ankle osteoarthritis with a range of the ankle joint movement of at least 10° or more. The osteotomy is obliquely directed cut across the distal tibia from proximal-medial to distal lateral and is of an opening-wedge type with the centre of rotation coincident with the centre of the tibiofibular joint. A laminar spreader instrument is inserted in the osteotomy to open the wedge until the lateral surface of the talar body is seen on X-ray to be in contact and congruent with medial articular surface of the lateral malleolus. Common obstacles which may prevent this contact and congruency are bony spurs present on the anterior side of fibula or on the lateral side of the tibia; these require removal. The opening-wedge osteotomy is held in position by an Ilizarov external fixator or internally fixed with a plate. Bone graft is taken from the iliac crest and inserted into the open wedge. If, after completion of the osteotomy, the dorsiflexion angle of the ankle joint does not exceed 0°, a Z-lengthening is performed of the Achilles tendon. In the DTOO for ankle osteoarthritis, the contact area of the ankle joint increases and decreases the load pressure per unit area. Furthermore, as the width of the ankle mortice is restored through the realignment of the body of the talus, instability at the ankle joint decreases. There is additional improvement with restoration of the inclination of the distal tibial articular surface as this directs the hindfoot valgus and corrects the alignment of the foot, with consequent improvement of ankle pain.