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Z Orthop Unfall 2012; 150(04): 368-373
DOI: 10.1055/s-0032-1314957
Georg Thieme Verlag KG Stuttgart · New York

Planungsgenauigkeit bei Open Wedge HTO

Precision in the Planning of Open Wedge HTO
S. Schröter
1   Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
,
J. Günzel
2   Innere Medizin, Schwarzwald-Baar-Klinikum Donaueschingen
,
T. Freude
1   Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
,
A. Ateschrang
1   Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
,
U. Stöckle
1   Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
,
D. Albrecht
1   Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
› Author Affiliations
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Publication History

Publication Date:
29 June 2012 (online)

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Zusammenfassung

Einleitung: Die High Tibial Osteotomy (HTO) wird als etablierte Methode bei Varusfehlstellung angesehen. Zur Quantifizierung der Varusfehlstellung kann die anatomische bzw. mechanische Beinachse bestimmt werden. Der Erfolg der HTO hängt wesentlich von der richtigen Einschätzung der präoperativen Achsabweichung und der exakt durchgeführten Korrektur ab. Ziel der retrospektiven Arbeit war die Überprüfung der Genauigkeit (max. Abweichung des mechanischen tibiofemoralen Winkels zwischen Planung und Nachuntersuchung ± 1,5°) bei Open Wedge HTO mit der TomoFix™-Platte in der frontalen Ebene. Material und Methode: Es erfolgte eine retrospektive Untersuchung von Patienten nach Open Wedge HTO mit der TomoFix™-Platte. Es wurden prä- und postoperative Ganzbeinstandaufnahmen in Standardtechnik angefertigt. Die mechanischen Winkel wurden bestimmt und mit der zeichnerischen Planung verglichen. Ergebnisse: Der mechanische tibiofemorale Winkel (mTFW) betrug präoperativ −5,33 ± 3,29° (varus) und bei der Nachuntersuchung −0,3 ± 3,0° (varus). Die mittlere Korrektur lag bei 4,9 ± 2,9°. Geplant wurde durchschnittlich eine Korrektur auf einen mTFW von 2,2 ± 1,6° (valgus). Es zeigte sich eine durchschnittliche Differenz von −2,5 ± 3,4° zur Planung. Das Planungsziel wurde mit der zeichnerischen Planungsmethode bei einer postulierten Toleranz im mTFW von ± 1,5° bei 73 % nicht erreicht. Schlussfolgerung: Mit der zeichnerischen Planung und der bekannten Operationstechnik konnten vergleichbare Ergebnisse zu anderen Arbeitsgruppen erzielt werden. Unter Berücksichtigung der selbst geforderten Genauigkeit ist die zeichnerische Planung nicht geeignet, diese Ziele hinreichend zu erreichen.

Abstract

Introduction: The high tibial osteotomy (HTO) is regarded as an established method for varus deformity. To quantify the varus deformity, the anatomic and the mechanical leg axis can be determined. The success of HTO depends on the correct assessment of the preoperative axis deviation and the exact as planned correction. The aim of the retrospective study was to verify the accuracy (± 1.5° of mechanical tibiofemoral angle tolerance compared to the planning) with the preoperative planning compared to the postoperative result after correction using the TomoFix™ plate in open wedge HTO. Materials and Method: A retrospective study of patients was carried out after open wedge HTO with the TomoFix™ plate. A full–weight bearing, long-standing anteroposterior radiograph of the whole lower extremity was performed before and after correction. The mechanical angles in the frontal plane were determined and compared with the plan as drawn. Results: The preoperative mechanical tibiofemoral angle (mTFA) was −5.33 ± 3.29° (varus) and at follow-up −0.3 ± 3.0° (varus). The mean correction was 4.9 ± 2.9°. The planned mTFA was 2.2 ± 1.6°(valgus). The corrected lower extremity showed a mean difference of −2.5 ± 3.4° in angle correction of the varus deformity as preoperatively assumed to be the optimal correction compared to the planning. The planning goal was not achieved in 73 % of the cases. Conclusion: The results are comparable to those of other publications. However, taking into account the required accuracy of the drawn plan combined with the surgical precedure, it is not possible to achieve results within the desired tolerance.

Schlüsselwörter

HTO - Osteotomie - Planung - Genauigkeit

Key words

HTO - osteotomy - planning - precision
 

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