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Re: Деформация голеней
Chris Wilson 11 Сентябрь 2005, 03:29
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As someone who has done over 50 open wedge HTO's, and only 2 for aesthetic reasons( big decision) here is my 2pennyworth.
1) ignore the impossibly idealistic "Stratec" diagram of an osteotomy around the tibial tubercle. If you start your osteotomy (by osteotome and never powersaw)just in the start of the flare of the tibial metaphysis, about 12 cm below the joint line,and aim for the fibula head, it will give you an osteotomy length of 65 mm in the average patient and this equates to 1 mm opening per 1 deg of desired correction;
2)go about 3/4 the way across the bone;
3) expand the osteotomy slowly;
4) if the correction is large( over 8 deg) or any cracks appear, or you put the limb axis in or beyond the neutral plane, so that the osteotomy is in tension rather than compression, then use a strong device( e.g. a Tomofix plate) rather than a minimal invasive device( e.g. a Pudu plate) - have both available if you're not sure, as the actual kit to do the osteotomy is a bit better on the Pudu set
5) make your approach antero-medial, and deep to the MCL in the sub-periosteal plane, rather than medial and through the MCL, as described by Pudu - much better result
regards
Chris Wilson
University
Hospital
Cardiff
UK
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