İrfan ESENKAYA, Nurzat ELMALI, MEHMET AKİF KAYGUSUZ, Mesut MISIRLIOĞLU, ALPER ATASEVER

Osteotomilerde proksimal tibiofibular eklemin yaralanma riskinin değerlendirilmesi

Amaç: İnsan kadavra ve amputat dizlerinde proksimal tibiofibular eklemin (PTFE) boyutları ve anatomik konumu ölçülerek değerlendirildi. Proksimal tibia medial açık kama osteotomisi (PT-MAKO) uygulanmış hastaların diz grafilerinde, osteotomi hattı ile PTFE arasındaki ilişki ve osteotomilerde PTFE’nin yaralanma riski değerlendirildi. Çalışma planı: Çalışmanın birinci aşamasında, altı insan kadavra tibiası ile altı taze amputasyon materyalinde (4 kadın, 8 erkek; ort. yaş 57), PTFE’nin lateral tibial kondille fibula başı arasındaki tibial bölümünün boyutları dijital kompas ile ölçüldü ve eklemin tibial yüzünün lateral tibia platosu posterior bölümüyle ilişkisi değerlendirildi. İkinci aşamada, PT-MAKO uygulanmış ardışık 44 hastanın (6 erkek, 38 kadın; ort. yaş 51) 46 dizine ait ön-arka, yan ve iç oblik grafilerde osteotominin PTFE ile ilişkisi değerlendirildi. Sonuçlar: Anatomik ölçümlerde, PTFE’nin tibia kondilinin posterolateralindeki kısmının elipsoid görünümlü eklem yüzünün uzun ekseninin ortalama 18.8 mm (dağılım 13 mm-20 mm), kısa ekseninin ortalama 14.9 mm (13 mm-17 mm) olduğu; eklem üst sınırının, lateral tibia platosu eklem yüzü posterior kenarından ortalama 6.3 mm (2 mm-11 mm) aşağıdan başladığı saptandı. İç oblik grafilerde, PTFE’nin proksimal yerleşimli olduğu olgularda, özellikle lateral korteks devamlılığı bozulan üç dizde (%6.5) osteotomi hattının PTFE’ye uzandığı gözlendi. Çıkarımlar: Oblik grafiler çekilmeden ve lateral tibia platosuna ait eğime paralel olarak yapılmayan osteotomi hattının posterolateral bölümü PTFE içerisine yönlenebilir. İyi değerlendirilmeden yapılan PT-MAKO uygulamalarında, lateral korteksin kırılması PTFE’ye hasar riskini artırmaktadır.

Anahtar Kelimeler:

Fibula, Tibia, Osteotomi, Osteoartrit, Diz eklemi, Ortopedik işlemler, Kadavra

Assessment of the vulnerability of the proximal tibiofibular joint to injury during osteotomies

Objectives: We evaluated the dimensions and anatomic localization of the proximal tibiofibular joint (PTFJ) in human cadaver and amputated knees. In addition, we assessed the relation between the osteotomy line and the PTFJ and its vulnerability to injury on radiographs of patients after proximal tibial medial open wedge osteotomy (PT-MOWO). Methods: In the first phase, dimensions of the tibial part of the PTFJ lying between the lateral tibial condyle and the fibular head were measured by digital calipers in six human cadaver and six fresh amputed tibiae (4 females, 8 males; mean age 57 years) to evaluate the relation between the tibial surface of the PTFJ and the posterior part of the lateral tibial plateau. In the second phase, anteroposterior, lateral, and medial oblique radiographs were assessed with respect to the relation of the osteotomies with the PTFJ following PT-MOWO in 46 knees of 44 consecutive patients (38 females, 6 males; mean age 51 years). Results: On cadaver and fresh amputation materials, the mean long and short axis dimensions of the ellipsoidal articular surface of the PTFJ in the posterolateral aspect of the tibial plateau measured 18.8 mm (range 13 mm to 20 mm) and 14.9 mm (13 mm- 17 mm), respectively. The upper articular border lied at a mean of 6.3 mm (2 mm to 11 mm) distal to the posterior border of the articular surface of the lateral tibial plateau. Medial oblique radiographs showed that the osteotomy line extended to the PTFJ in cases in which it was proximally located, particularly in three cases (6.5%) where lateral cortex continuity was interrupted. Conclusion: The osteotomy line may encroach upon the PTFJ unless preoperative oblique radiographs are evaluated and a parallel course to the tibial slope of the lateral tibial plateau is followed. In addition, insufficient evaluation of PT-MOWO candidates may result in damage to the lateral cortex, which increases the risk for injury to the PTFJ.

Keywords:

Fibula, Tibia, Osteotomy, Osteoarthritis, Knee Joint, Orthopedic Procedures, Cadaver,

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