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Planning of High Tibial Osteotomy

机译：胫骨高位截骨术的规划

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Introduction: High Tibial Osteotomy (HTO) is an establish technique for the treatment of varus malaligned knees. The aim of HTO is to reduce the load on the medial compartment by shifting the mechanical axis toward the lateral compartment. It is indisputable that appropriate patient selection, precise surgical planning, and correct operative techniques can provide favorable treatment outcomes of HTO. Method: Case Series. We reported four cases of HTO during clinical attachment in Gleneagles Hospital Kuala Lumpur Malaysia. Two cases are simple Open Wedge HTO, and two cases are Open Wedge HTO that performed simultaneously with posterolateral corner reconstruction. The assessment of lower limb alignment is based on an examination of clinical assessment and full standing radiographs, andplanned correction was achieved when the weight-bearing line passedthrough a target point located at 62% (Fujisawa point) ofthe tibial plateau width measured from themedial border of the tibial plateau. Result: We performed 9~(0), 11~(0), and 6~(0)corrections to shift the weight bearing area to Fujisawa point. Post operative radiologic measurement shown all patients had a good alignment with 6~(0), 5~(0), and 6~(0)valgus over correction, and with insignificant change of tibial slope. PLC instability was reconstruct with modified Larson’s technique by using semitendinous graft. In these cases, we used Tomifix plate (Sythes, Switzerland) as a bridging internal fixation with the principle of a locking compression plate (LCP), and ChronOS (Sythes, Switzerland) as a bone void filler. Conclusion: To achieve good results with HTO requires proper patient selection, good surgical planning, accurate surgical technique, and discipline rehabilitation. Reconstruction of the ligament abnormalities that affect the stability around the knee joint is necessary to achieve better results.
机译：简介：高胫骨截骨术（HTO）是治疗膝内翻畸形的一项既定技术。 HTO的目的是通过将机械轴移向外侧隔室来减轻内侧隔室的负荷。毫无疑问，适当的患者选择，准确的手术计划和正确的手术技术可以为HTO提供良好的治疗效果。方法：案例系列。我们在马来西亚吉隆坡鹰阁医院进行临床依恋期间报告了4例HTO病例。有两种情况是简单的开放式楔形HTO，有两种情况是与后外侧角重建同时进行的开放式楔形HTO。下肢对中的评估是基于临床评估和完全站立的X射线照片的检查，并且当负重线穿过目标点位于胫骨平台宽度的62％（藤泽点）时，可以实现计划的矫正，该目标点位于胫骨平台的中间边界胫骨高原。结果：我们执行了9〜（0），11〜（0）和6〜（0）校正，以将承重区域移动到藤泽点。术后影像学检查显示，所有患者在矫正后均与6〜（0），5〜（0）和6〜（0）外翻吻合良好，胫骨斜率变化不明显。 PLC的不稳定性是使用改良的Larson技术通过半腱移植重建的。在这种情况下，我们使用Tomifix板（Sythes，瑞士）作为内部固定的桥梁，采用锁定加压板（LCP）的原理，而ChronOS（Sythes，瑞士）作为骨空隙填充剂。结论：要获得良好的HTO效果，需要适当的患者选择，良好的手术计划，准确的手术技术和学科康复。必须重建影响膝盖关节周围稳定性的韧带异常，以取得更好的效果。

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