Proksimal tibia medial açık kama osteotomisinde kamalı plak uygulaması

Amaç: Proksimal tibia medial açık kama osteotomisinde tespit için kamalı plak uygulamasında endikasyonlar, cerrahi teknik ve sonuçlar değerlendirildi. Çalışma planı: Medial kompartman osteoartrozu olan ardışık 38 hastanın (5 erkek, 33 kadın; ort. yaş 51; dağılım 36-65) 40 dizine proksimal tibia medial açık kama osteotomisi uygulandı. Tüm dizlere artroskopi uygulandıktan sonra, medial eklem aralığının 3-4 cm distalinden laterale ve proksimale doğru oblik bir hat üzerinden osteotomi uygulandı; lateral korteks kesilmemeye çalışıldı; tespit için tasarımı yazar tarafından yapılan, osteotomi yüzeylerini plak üzerindeki kama şeklindeki çıkıntı- larla destekleyen plaklar kulanıldı. Plaklar 2 ve 4 delikli dikdörtgen ile 4 delikli ters “L” şeklinde idi; kama yüksekliği 5-15 mm arasında değişmekteydi. Plaklar, üzerindeki deliklere tam uyum sağlayan vidalarla sabitlendi. Greft olarak sekiz dizde trikortikal, 25 dizde bikortikal iliyak kemik otogrefti, yedi dizde allogreft kullanıldı. Klinik ve fonksiyonel değerlendirme HSS puanlama sistemine göre yapıldı. Ortalama izlem süresi 17 ay (dağılım 9-36 ay) idi. Sonuçlar: Ameliyat öncesinde ortalama 4.3° (0°-10°) varus olan tibiofemoral açı, son kontrolde 5.8° (3°-11°) valgus olarak ölçüldü. Ameliyat öncesinde ortalama 59 (dağılım 52- 75) olan HSS skoru ameliyat sonrasında 90 (dağılım 79-96) bulundu. Komplikasyon olarak, ameliyat sırasında üç dizde (%7.5) lateral plato kırığı, 11 dizde (%27.5) yer değiştirmemiş lateral korteks kırığı oluştu. Bir hastada (%2.5) yara iyileşmesinde ve kaynamada gecikme ve distal vidalardan birinde kırılma görüldü. Çıkarımlar: Tek kompartman tutulumlu dizin medial osteoartritinde, proksimal tibia medial açık kama osteotomisinin tespitinde kamalı plak kullanılması, elde edilen düzeltme derecesini korumakta ve fonksiyonel rehabilitasyon için erken harekete izin verecek yeterli stabiliteyi sağlamaktadır.

Anahtar Kelimeler:

Diz eklemi, Osteoartrit, Osteotomi, Tibia

Fixation of proximal tibia medial opening wedge osteotomy using plates with wedges

Objectives: The indications, surgical technique, and the results of fixation using plates with metal wedges were assessed in proximal tibia medial opening wedge osteotomy. Methods: Forty knees in 38 consecutive patients (5 men, 33 women; mean age 51 years; range 36 to 65 years) with medial compartment osteoarthritis of the knee were treated with proximal tibia medial opening wedge osteotomy using plates with wedges. Following arthroscopic debridement, medial proximal tibial osteotomy was performed laterally and proximally on an oblique line and 3-4 cm distal to the medial joint space. Disruption of the lateral cortex was avoided. Fixation of the osteotomy was performed using plates with wedges. The plates which were designed by the author were either rectangular in shape with two or four holes or had an inverse “L” shape with four holes, bearing metal wedges at varying heights from 5 to 15 mm. The plates were fixed with screws. Tricortical (n=8) or bicortical (n=25) iliac bone autografts and allografts (n=7) were used. Clinical and functional evaluations were made using the HSS scoring system. The mean follow-up was 17 months (range 9 to 36 months). Results: The mean preoperative and postoperative tibiofemoral angles were 4.3° varus (0°-10°) and 5.8° valgus (3°-11°), respectively. The mean HSS score increased from 59 (range 52 to 75) preoperatively to 90 (range 79 to 96) on final evaluations. During surgery, lateral tibial plateau fissures and lateral cortex fractures occurred in three (7.5%) and 11 (27.5%) knees, respectively. Delayed healing and delayed union and breakdown of a distal screw were encountered in one patient (2.5%). Conclusion: Fixation of proximal tibia medial opening wedge osteotomy using plates with wedges provides adequate stabilization to maintain the desired correction and to allow early functional rehabilitation in the treatment of medial osteoarthritis of the knee.

Keywords:

Knee Joint, Osteoarthritis, Osteotomy, Tibia,

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