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Bildgebung und präoperative Planung der Tibiakopfosteotomie

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Zusammenfassung

Tibiale Umstellungsosteotomien sind zur Behandlung einer medialen Gonarthrose weit verbreitet. Der ideale Patient ist aktiv, jünger als 55 Jahre und weist eine unikompartimentäre Arthrose bei bandstabiler Varusdeformität <10° auf. Eine sorgfältige präoperative Planung einer hohen tibialen Osteotomie ist für das Erreichen eines gewünschten Korrekturwinkels notwendig. Fujisawa fand dann gute postoperative Ergebnisse, wenn die postoperativ erreichte Traglinie durch die 2/3-Koordinate des lateralen Tibiaplateaus verlief. Hernigou beschrieb gute Langzeitergebnisse nach aufklappender Osteotomie, wenn die Varusstellung des Beins exakt korrigiert wurde. Coventry beobachtete schlechtere klinische Langzeitergebnisse nach lateral schließender Osteotomie, wenn der postoperative femurotibiale Winkel <8° Valgus betrug.

Die empfohlenen Methoden der präoperativen Planung variieren zwischen simpler Schätzung des notwendigen Korrekturwinkels, Planungszeichnungen auf Röntgenbildern und der Verwendung von digitalen radiologischen Messapparaten. Unabhängig von der Planungsmethode sollte die reproduzierbare und exakte Korrektur der Beinachse Ziel der Umstellungsoperation sein. Dieses Kapitel beschreibt verschiedene Planungsmethoden, die die Zuverlässigkeit einer tibialen Umstellungsosteotomie erhöhen sollen.

Abstract

Valgus-producing osteotomy of the proximal tibia is a well-established treatment for medial femorotibial osteoarthritis in the varus knee. The ideal patient is active, under 55 years of age, has a stable varus deformity of less than 10°, a good bone stock, and an osteoarthritis stage that is restricted to the medial compartment of the knee. Coventry reported a failure rate in proximal tibial osteotomy to be significantly higher when the postoperative alignment was less than 8° of anatomical valgus. Hernigou noted better clinical long-term results in cases with a precise correction of malalignment.

There are different preoperative planning methods varying between simple estimates of correction angles and specific radiographic planning tools. The reproducibility of operative outcome with regard to a predictable anatomic alignment and functional recovery must have high priority. This chapter deals with different preoperative planning methods to improve the reliability of surgical results after tibial osteotomy.

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Authors and Affiliations

  1. Orthopädische Universitätsklinik des Saarlandes, Homburg/Saar

    D. Pape, R. Seil, F. Adam, S. Rupp & D. Kohn

  2. Klinik für Unfall- und Wiederherstellungschirurgie, Henriettenstift, Hannover

    P. Lobenhoffer

  3. Orthopädische Universitätsklinik des Saarlandes, Kirrbergerstraße Gebäude 37, 66421, Homburg/Saar

    D. Pape

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  1. D. Pape
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Correspondence to D. Pape.

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Pape, D., Seil, R., Adam, F. et al. Bildgebung und präoperative Planung der Tibiakopfosteotomie. Orthopäde 33, 122–134 (2004). https://doi.org/10.1007/s00132-003-0585-0

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