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Bildgebung und präoperative Planung bei perigenikulären Osteotomien

Imaging and preoperative planning for osteotomies around the knee

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Zusammenfassung

Physiologische Achsenverhältnisse des menschlichen Beins sind in den Raumebenen exakt definiert. Ursachen für Abweichungen der physiologischen Achse sind konstitutionelle Fehlstellungen, degenerative Gelenkveränderungen und Fehlstellungen nach Frakturen. Die korrigierende, kniegelenknahe Umstellungsosteotomie kann die Achsenverhältnisse wieder normalisieren, wenn die Fehlstellung in der Nähe des Kniegelenkzentrums liegt. Wesentliche Faktoren zur Einschätzung von Achsabweichungen sind die mechanische Traglinie, die mechanischen Achsen von Femur und Tibia, die Gelenklinien sowie die Gelenkzentren von Hüfte, Knie und Sprunggelenk. Eine sorgfältige präoperative Planung einer Osteotomie ist für das Erreichen eines gewünschten Korrekturwinkels notwendig. Bei der Korrektur einer Varusgonarthrose wird in der Regel eine leichte Überkorrektur empfohlen, so dass die mechanische Achse des Beins das Tibiaplateau in Höhe der lateralen Spina schneidet (62 % der Tibiaplateaubreite lateralseitig). Bei Valguskorrekturen wird dagegen empfohlen, den Verlauf der postoperativen Traglinie auf physiologische Werte einzustellen (44 % der Tibiaplateaubreite lateralseitig). Individualisierte Korrekturen werden zunehmend bevorzugt, um die zugrundeliegenden Pathologien des einzelnen Patienten besser berücksichtigen zu können.

Abstract

Physiologic alignment of the human lower leg is well defined. The etiology for malalignment comprises constitutional, degenerative and posttraumatic conditions. Osteotomies around the knee can correct the malalignment, provided that the origin of deviation is in proximity of the knee center. Crucial factors for the evaluation of axis deviation are the weight-bearing line, the mechanical axes of femur and tibia, the joint line angles and the center of the hip, knee and upper ankle joint. Careful preoperative planning is mandatory for reproducible clinical results. For the treatment of varus osteoarthritis of the knee, a slight overcorrection to the 62% width of the lateral tibial plateau is frequently advocated. In valgus knees, a correction of the postoperative weight-bearing line to physiologic conditions (44% of the lateral tibial width) is regarded to be sufficient. Recently, individualized planning of the correction angle is advocated to better address the underlying pathology of each patient.

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  1. Orthopädische Abteilung, Centre Hospitalier de Luxembourg – Clinique d’Eich (Akademisches Lehrkrankenhaus der Universität des Saarlandes), 78, rue d’Eich, 1460, Luxembourg, Luxemburg

    D. Pape, A. Hoffmann & R. Seil

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Pape, D., Hoffmann, A. & Seil, R. Bildgebung und präoperative Planung bei perigenikulären Osteotomien. Oper Orthop Traumatol 29, 280–293 (2017). https://doi.org/10.1007/s00064-017-0496-6

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