Corrective Tibial Osteotomy in Young Adults Using an Intramedullary Nail
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Purpose: The purpose of this study was to document results of a less invasive technique of open wedge proximal tibial osteotomy (PTO) for the varus knee in young adults using an intramedullary tibial nail. Materials and Methods: We prospectively studied 24 knees in 16 young patients with varus knee deformity. The mean follow-up was 54 months (range, 36 to 107 months) and the mean age of patients at the time of operation was 25.8 years (range, 18 to 40 years). The open wedge PTO was performed below tibial tuberosity using a percutaneous multiple drill-hole technique. Conventional intramedullary tibial nail was used for fixation without bone graft. Radiographic evaluations were made using mechanical alignment (MA), posterior tibial slope angle, and Insall-Salvati ratio. Union time, loss of correction, implant failure, and associated complications were also investigated. Results: The mean MA was significantly changed from −9.7o preoperatively to 1.1o at the final follow-up (p<0.001). There was no significant change in the proximal tibial anatomy and patellar height. All patients achieved radiographic bony union at an average of 3.1 months without loss of correction. The only complication was knee pain due to nail prominence in 3 patients. Conclusions: Radiographic evaluation indicated that PTO using an intramedullary tibial nail leads to significant improvement in radiographic parameters without changes in posterior tibial slope or patellar height. We found that this technique could be a less invasive and effective alternative for correction of the varus knee in young adults.
Abstract
Purpose: The purpose of this study was to document results of a less invasive technique of open wedge proximal tibial osteotomy (PTO) for the varus knee in young adults using an intramedullary tibial nail. Materials and Methods: We prospectively studied 24 knees in 16 young patients with varus knee deformity. The mean follow-up was 54 months (range, 36 to 107 months) and the mean age of patients at the time of operation was 25.8 years (range, 18 to 40 years). The open wedge PTO was performed below tibial tuberosity using a percutaneous multiple drill-hole technique. Conventional intramedullary tibial nail was used for fixation without bone graft. Radiographic evaluations were made using mechanical alignment (MA), posterior tibial slope angle, and Insall-Salvati ratio. Union time, loss of correction, implant failure, and associated complications were also investigated. Results: The mean MA was significantly changed from −9.7o preoperatively to 1.1o at the final follow-up (p<0.001). There was no significant change in the proximal tibial anatomy and patellar height. All patients achieved radiographic bony union at an average of 3.1 months without loss of correction. The only complication was knee pain due to nail prominence in 3 patients. Conclusions: Radiographic evaluation indicated that PTO using an intramedullary tibial nail leads to significant improvement in radiographic parameters without changes in posterior tibial slope or patellar height. We found that this technique could be a less invasive and effective alternative for correction of the varus knee in young adults.
참고문헌 (30)
- Dong Chul Lee, "High Tibial Osteotomy", Knee Surgery and Related Research, 24(2), pp.61~69 (2012), 대한슬관절학회
- Su Chan Lee, "The Short-term Follow-up Results of Open Wedge High Tibial Osteotomy with Using an Aescula Open Wedge Plate and an Allogenic Bone Graft: The Minimum 1-Year Follow-up Results", Clinics in Orthopedic Surgery, 2(1), pp.47~54 (2010), 대한정형외과학회
- Marti RK, "Proximal tibial varus osteotomy : indications, technique, and five to twenty-one-year results", J Bone Joint Surg Am, 83, pp.164~170 (2001)
- Noyes FR, "Opening wedge high tibial osteotomy : an operative technique and rehabilitation program to decrease complications and promote early union and function", Am J Sports Med, 34, pp.1262~1273 (2006)
- Shim JS, "High tibial open wedge osteotomy below the tibial tubercle : clinical and radiographic results", Knee Surg Sports Traumatol Arthrosc, 21, pp.57~63 (2013)
- Iorio R, "Open-wedge high tibial osteotomy : comparison between manual and computer-assisted techniques", Knee Surg Sports Traumatol Arthrosc, 21, pp.113~119 (2013)
- Madry H, "Part I : analysis of the lateral meniscus", Knee Surg Sports Traumatol Arthrosc, 21, pp.39~48 (2013)
- Bombaci H, "The effect of open wedge osteotomy on the posterior tibial slope", Acta Orthop Traumatol Turc, 39, pp.404~410 (2005)
- Pape D, "Preoperative planning for high tibial osteotomies", Oper Tech Orthop, 17, pp.2~11 (2007)
- Staubli AE, "TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia: early results in 92 cases", Injury, 34(2), pp.B55~B62 (2003)
- Brouwer RW, "The open versus the closed-wedge technique", J Bone Joint Surg Br, 87, pp.1227~1232 (2005)
- Stoffel K, "Open wedge high tibial osteotomy : biomechanical investigation of the modified Arthrex Osteotomy Plate(Puddu Plate)and the TomoFix Plate", Clin Biomech(Bristol, Avon), 19, pp.944~950 (2004)
- Olin MD, "High tibial osteotomy: will new techniques provide better results?", Curr Opin Orthop, 12, pp.8~12 (2001)
- Agneskirchner JD, "Primary stability of four different implants for opening wedge high tibial osteotomy", Knee Surg Sports Traumatol Arthrosc, 14, pp.291~300 (2006)
- Galla M, "High tibial open wedge valgus osteotomy stabilized with the tomofix?", Plate fixator. Oper Orthop Traumatol, 16, pp.397~417 (2004)
- Machen MS, "Should full-length standing anteroposterior radiographs replace the scanogram for measurement of limb length discrepancy?", J Pediatr Orthop B, 14, pp.30~37 (2005)
- Dugdale TW, "Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length", Clin Orthop Relat Res, 274, pp.248~264 (1992)
- Kim SJ, "Biplanar medial open-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a novel technique and follow-up", Oper Tech Orthop, 17, pp.29~37 (2007)
- Kellgren JH, "Radiological assessment of osteo-arthrosis", Ann Rheum Dis, 16, pp.494~502 (1957)
- Cooke TD, "Frontal plane knee alignment : a call for standardized measurement", J Rheumatol, 34, pp.1796~1801 (2007)
- Hernigou P, "Proximal tibial osteotomy for osteoarthritis with varus deformity : a ten to thirteen-year follow-up study", J Bone Joint Surg Am, 69, pp.332~354 (1987)
- Paley D, "Osteo tome and Gigli saw techniques", Orthop Clin North Am, 22, pp.613~624 (1991)
- Paley D, "Deformity planning for frontal and sagittal plane corrective osteotomies", Orthop Clin North Am, 25, pp.425~465 (1994)
- Gordon JE, "Femoral deformity in tibia vara", J Bone Joint Surg Am, 88, pp.380~386 (2006)
- Quinn JV, "Appearance scales to measure cosmetic outcomes of healed lacerations", Am J Emerg Med, 13, pp.229~231 (1995)
- Lang GJ, "Proximal third tibial shaft fractures. Should they be nailed?", Clin Orthop Relat Res, 315, pp.64~74 (1995)
- Gaasbeek RD, "Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera : a new technique", Knee, 11, pp.457~461 (2004)
- Preston CF, "Osteotomy about the knee : applications, techniques, and results", J Knee Surg, 18, pp.258~272 (2005)
- Hernigou P, "Open wedge tibial osteotomy : combined coronal and sagittal correction", Knee, 9, pp.15~20 (2002)
- Lustig S, "Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy", Knee Surg Sports Traumatol Arthrosc, 21, pp.32~38 (2013)