Preoperative tibiofemoral angle predicts survival of proximal tibia osteotomy

A prospective group study was done to clarify whether perioperative variables such as preoperative and postoperative tibiofemoral angles influence the survivorship of proximal tibia osteotomy as measured by conversion to arthroplasty and patient dissatisfaction. The results of 93 proximal tibial osteotomies in 82 consecutive patients with medial compartment osteoarthrosis were followed up for a mean of 10.9 years. All data were analyzed by the Kaplan-Meier survivorship method and the multivariate Cox proportional hazards model. Only the preoperative tibiofemoral angle was a predictor of conversion to arthroplasty and patient dissatisfaction. The ideal prognostic cutoff angle was 9 degrees or less varus. Increasing the preoperative varus alignment 1 degrees would result in a 1.2 (95% confidence intervals, 1.02-1.50) times higher risk of conversion to a total knee arthroplasty and a 1.5 (95% confidence intervals, 1.27-1.76) times higher chance of patient dissatisfaction. Factors such as age, gender, body mass index, Ahlback's classification, and postoperative tibiofemoral angle were not significant. We think that proximal tibial osteotomy should be considered for patients with medial compartment osteoarthrosis and a preoperative varus alignment of 9 degrees or less, whereas arthroplasty is a more suitable alternative for patients with preoperative varus alignment greater than 9 degrees.     

Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length.

To calculate the tibial wedge size in preoperative planning of high tibial osteotomy, the weight-bearing line (center femoral head to center tibiotalar joint) is first restored to a selected position on the lateral tibial plateau. Ten full-standing roentgenograms were examined and used to derive mathematical formulas for correcting limb alignment. A 3-4-mm shift in the weight-bearing line on the tibia occurred with each degree of tibiofemoral angulation. This showed that the position of the weight-bearing line is sensitive to the lengths of the tibia and femur as well as the surgeon's preoperative calculations. The problem of increased varus angulation due to slack lateral ligament restraints with distraction of the tibiofemoral joint was analyzed. Trigonometric analysis showed that each millimeter of lateral tibiofemoral joint separation caused about 1 degree varus angular deformity, requiring subtraction in preoperative calculations to avoid overcorrection. An algorithm was designed to evaluate complex lower-limb alignments.     

The study of Maquet dome high tibial osteotomy. Arthroscopic-assisted analysis

A review of 118 Maquet valgus high tibial osteotomies, secured with Charnley's external compression fixator, included 110 cases of primary osteoarthritis, six cases of osteonecrosis, and two cases of traumatic arthritis. Preoperatively, the mechanical axis of alignment showed varus deformity with an average of 9.6 degrees, while the final follow-up evaluation demonstrated valgus alignment with an average of 4.7 degrees. According to the criteria of Insall et al. the knee scores improved from 63.3 preoperatively to 88.8 postoperatively. The results were excellent or good in 84.8% of 118 knees followed an average of 27 months (range, 12-84 months). A significant relationship existed between the success of the correction of the mechanical axis and the knee's functional result. Also, the severity of the preoperative coronal angular deformity of the knee joint had a negative relationship with the final knee function. There were 39 (33.1%) complications, including 13 recurrences of varus deformity, 13 pin-tract infections, five peroneal nerve palsies, and two paralyses of the extensor hallucis longus. Preoperative arthroscopic grading according to the criteria of Fujisawa et al. and the additional point-counting method did not adequately predict the knee's functional outcome, but postoperative arthroscopic grading was of some prognostic value.     

下颌骨截骨术后咬肌变化的研究

目的 观察下颌角截骨术后咬肌形态的动态变化.方法 采集120例下颌骨截骨受术者术前及术后3、6、12个月时头颅CT数据,并进行三维重建,通过软件平台设定合适的阈值范围,分割出咬肌组织.经过断层叠加创建咬肌的三维分割体,由软件输出咬肌体积等三维信息.再选定3处横截面,即A平面:过咬合平面水平,下颌升支前后缘中点的平面;B平面:A平面上1cm;C平面:A平面下1cm.在各横截面上测量咬肌的面积和厚度,观察咬肌在不同水平上的面积、厚度随时间的变化趋势.结果 咬肌体积与横截面面积的变化趋势基本相同,体积在术后3、6、12个月时分别缩小至术前的82.02%、77.00%和80.43%,术后各时期体积均明显小于术前(P＜0.05).A、B、C 3个平面咬肌面积的变化:A平面在术后3、6、12个月分别缩小至术前的85.81%、78.86%和81.56%,B平面分别萎缩至术前的80.94%、75.03%和77.04%,而C平面近似原下颌角角区下降最多,分别为13.46%、11.48%和13.89%.各测量数值与术前比较均有显著差异(P＜0.05,P＜0.05,P＜0.01).咬肌厚度的变化:A平面在术后3、6、12个月时分别缩小16.54%、15.85%、4.69%,术后12个月时与术前比较无明显差异.而B、C平面在各随访时间的厚度与术前比较均有显著差异(P＜0.05).结论 下颌角截骨术使咬肌发生了自行萎缩,原下颌角角区(C平面)的咬肌萎缩最为明显.因此在下颌骨截骨的术前的预测中应考虑到咬肌的萎缩,以更好地指导手术.     

Crescentic transmalleolar osteotomy for optimal exposure of the medial talar dome

A review of the literature suggests that surgical treatment of transchondral talar dome fractures affords superior results over lengthy conservative therapy. Medial lesions have been reported most often. The authors perform stress views in acute and chronic ankle injuries, as there are often associated ligament ruptures with suspected talar dome fractures, and routinely use an air-contrast radiographic technique for visualization of the continuity of the articular cartilage. An arthrogram is performed for definitive diagnosis of ligamentous injury. A new osseous surgical approach to the medial talar dome has been presented, entailing a crescentic osteotomy of the medial malleolus. The distinct advantage has proven to be enhanced exposure to the middle and posterior aspects of the medial margin of the talus. The configuration of the crescentic osteotomy is also amenable to internal fixation and tension band wiring has been recommended. Unrestricted access to the site of a medial transchondral talar dome fracture through this osteotomy is the benefit of a technically well-performed procedure.     

Focal dome osteotomy for the correction of tibial deformity in children

Tibial deformity in childhood often combines torsional and angular malalignment. A focal dome osteotomy was performed, proximally or distally, in 39 tibiae in 31 patients. In 33 limbs, the primary deformity was varus (with internal torsion). The osteotomy was held with K-wires and a plaster cast. The mean age at surgery was 10.25 years and the minimum follow-up 24 months. All osteotomies united and no compartment syndrome occurred. Postoperatively, two patients (5%) had temporary neurological deficits. Thirty of 31 patients had good clinical and radiological correction of alignment. Recurrent deformity was seen in one patient with hypophosphataemic rickets.     

Double dome osteotomy for the treatment of cubitus varus in children

Purpose

The purpose of this study was to report double dome osteotomy used to correct paediatric cubitus varus and to avoid lateral prominence after correction.

Methods

Eighteen children with cubitus varus underwent double dome osteotomy. Preoperative templating created from radiographs was used to determine the bone cuts. Double dome osteotomy created a proximal and distal cut, then varus deformity and sagittal alignment were corrected. The osteotomies were fixed with K-wires and immobilised in a long-arm cast. Radiographics and clinical histories were evaluated. Ulno-humeral angle pre and postoperative, range of motion and lateral prominent index were evaluated.

Results

The osteotomy was performed in 18 patients, with an average age of 7.5 years. All patients ended up with flexion of 130° or greater with full and symmetrical pronation and supination. The average ulno-humeral angle difference compared to the uninjured side was 3.27°. The mean of the lateral prominent index was −0.91. The mean follow up was 50.3 months (30–115 months). All of the patients had excellent clinical and radiographic alignment. No revisions were made in this series. One transient radial nerve palsy and one superficial infection occurred.

Conclusion

This series demonstrates that double dome osteotomy can provide reliable correction of varus deformity and prevent lateral prominence with a minimal complication rate.     

下颌角弧形截骨术对咀嚼功能的影响

目的 通过对下颌角弧形截骨手术前后咬合力的研究,分析手术对咀嚼功能的影响,从而进一步指导临床.方法 对2008年1至10月行下颌角弧形截骨术的20例女性患者(年龄16～38岁)手术前后切牙区、双侧前磨牙区、双侧磨牙区最大咬合力进行测定,比较手术前及术后6个月时咬合力的变化.结果 术前前牙区、右侧前磨牙区、左侧前磨牙区、右侧磨牙区、左侧磨牙区最大咬合力分别为:(11.7±3.9)kg、(23.2±1.6)kg、(30.9±2.3)kg、(35.6±4.2)kg、(38.5±3.1)kg.术后6个月测定的最大咬合力分别为:(11.9±2.1)kg、(23.0±4.5)kg、(31.0±1.8)kg、(35.9±3.5)kg、(38.5±2.7)kg,各牙区最大咬合力达到甚至略高于术前水平.术后6个月与术前比较差异无统计学意义(P>0.05).结论 下颌角弧形截骨手术对最大咬合力及咀嚼功能无明显影响.     

Medpor假体修复下颌角截骨术后下颌角部分缺失畸形

目的:不恰当的下颌角截骨术或者截骨过多会造成下颌角部分缺失畸形,本文选择了一组下颌角截骨术后下颌角部分缺失患者,来研究Medpor假体修复下颌角截骨术后下颌角部分缺失畸形的效果方法:选择本科室3年来5例下颌角截骨术后下颌角部分缺失患者,完善术前检查与分析。在全麻下应用Medpor假体矫治并用钛钉进行固定。术后观察治疗效果,并在6个月后对所有患者进行随访,调查患者满意度。结果:所有5例患者矫治后Ⅰ期愈合,所有患者两下颌角间宽度增加,侧面观下颌角线条自然清晰,恢复了下颌角的正常美学标准。6个月后随访,所有患者均对治疗效果表示满意结论:应用Medpor假体矫治并用钛钉进行固定,可有效地修复因下颌角截骨术后所造成的下颌角部分缺失,使患者下颌角达到一个理想的美学标准。     

The Akron midtarsal dome osteotomy in the treatment of rigid pes cavus: a preliminary review

This study reviews the preliminary results of a previously unreported midtarsal "dome" osteotomy, all operations being performed by a single surgeon. The procedure is centered at the apex of the deformity and allows for extensive angular and rotational correction of the midfoot. The initial review has demonstrated 67% satisfactory results in 22 patients representing 35 feet. Satisfactory results were obtained in 15 of 16 feet (94%) in patients greater than 8 years of age. Careful short-term analysis suggests that the midtarsal "dome" osteotomy is best indicated for the child greater than 8 years of age with a rigid cavus or cavovarus foot.     

The effect of laser osteotomy on bone healing

Osteotomy of the rat femur performed by the laser was compared to osteotomty made by a hand-saw cut. It was noted that, radiographically and histologically, there was a delay in healing in the laser group, but biomechanical testing failed to reveal any significant difference in bone strength.     

The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study

Background  

We performed a matched case control study to assess the effect of prior high tibia valgus producing osteotomy on results and complications of total knee arthroplasty (TKA).     

The influence of foot geometry on the calcaneal osteotomy angle based on two-dimensional static force analyses

Background  

Malalignment of the hindfoot can be corrected with a calcaneal osteotomy (CO). A well-selected osteotomy angle in the sagittal plane will reduce the shear force in the osteotomy plane while walking. The purpose was to determine the presence of a relationship between the foot geometry and loading of the calcaneus, which influences the choice of the preferred CO angle.     

The long-term effect on the tibiofemoral compartment of the knee joint of comminuted fractures of the patella

We have studied the long-term effect of comminuted fractures of the patella with particular reference to the development of degenerative changes in the tibiofemoral joint. Degenerative changes which could convincingly be ascribed to the original injury were found in only one case, but we stress that the numbers are small, and that careful search should be made at operation for damage to the femoral condyles.     

The effect of high tibial osteotomy on osteoarthritis of the knee

Summary High tibial osteotomies were performed on 136 osteoarthritic knees for correction of varus deformity. Before osteotomy all patients experienced moderate or severe pain, and the knees showed lateral thrust on weight-bearing. The patients were followed up for one to five years. Marked relief of pain was obtained in 112 knees, and the patients were satisfied with the result of operation in 122. These painless knees showed no lateral thrust, and in the majority the deformity had been adequately corrected, with post-operative femoro-tibial angles (standing) ranging from 165° to 174°. Four of 28 knees with femoro-tibial angles of 175° to 179°, when measured one year after operation, showed recurrence of varus deformity three years after osteotomy. Preoperative ranges of knee motion were well maintained after osteotomy even when arthrotomy had also been undertaken. Intra-articular assessment in two patients, several years after operation, showed that the most degenerated portions of the articular surface were completely covered by a fibrocartilagenous layer, with no bare bone.High tibial osteotomy is most effective in osteoarthritic knees with varus deformity, when correction is made to a femoro-tibial angle (standing) of 170° (10° valgus).

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Résumé Une ostéotomie de l'extrémité supérieure du tibia a été réalisée chez 125 malades (136 genoux) porteurs d'une arthrose sur genu varum. Avant l'intervention, tous les sujets se plaignaient de douleurs plus ou moins importantes et présentaient une augmentation de la déformation lors de l'appui.Le recul est de 1 à 5 ans. Une diminution notable des douleurs a été obtenue sur 112 genoux et 122 malades sont satisfaits de l'intervention. Les genoux stables et indolores ne présentent plus de bâillement externe et ont été en majorité corrigés de façon satisfaisante, avec un angle fémoro-tibial compris entre 165° et 174°. Sur les 28 genoux comportant un angle de 175° à 179° un an après l'opération, 4 ont donné lieu à une récidive du varus trois ans après l'ostéotomie. La mobilité pré-opératoire a été conservée, même dans les cas où une arthrotomie a été associée à l'ostéotomie. Un bilan intraarticulaire, effectué chez 2 malades, plusieurs années après l'ostéotomie, a montré que les parties les plus détruites de la surface articulaire étaient complétement recouvertes d'un tissu fibro-cartilagineux.L'ostéotomie tibiale est efficace dans l'arthrose sur genu varum, surtout si la correction réalise un angle fémoro-tibial de 170°, soit 10° de valgus.

     

Long-term results of the Salter pelvic osteotomy

We report the long-term results obtained with Salter's innominate osteotomy over an average follow-up time of 24 years. In 8 of 9 hips the innominate osteotomy was combined with an intertrochanteric femoral osteotomy. On average the acetabular angle was improved by 12 degrees. By 11 years post-operatively the acetabular angle had stabilized at a mean of 16 degrees, subsequently remaining the same through the follow-up period. The centre angle was improved by approximately 20 degrees. By 8 years post-operatively it was in the normal range around 27 degrees, remaining unchanged until the most recent follow-up examination. Among the 9 patients who were followed up there was only one mild deformity of the femoral head. We recommend Salter's innominate osteotomy for the treatment of dysplastic acetabulae with an acetabular angle of not much more than 40 degrees, for patients 2-4 years of age, and occasionally up to the age of 6.