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DOI: 10.1055/s-2007-965549
© Georg Thieme Verlag KG Stuttgart · New York
Computerassistierte valgisierende Tibiakopfosteotomie
Computer-Assisted Open-Wedge OsteotomyPublication History
Publication Date:
02 October 2007 (online)
![](https://www.thieme-connect.de/media/zfo/200704/lookinside/thumbnails/10.1055-s-2007-965549-1.jpg)
Zusammenfassung
Ziel: Die aufklappende Tibiakopfosteotomie ist ein etabliertes Verfahren zur Behandlung der unikompartimentellen Gonarthrose bei jungen Patienten. Der Erfolg der Operation wird wesentlich durch das Erreichen einer korrekten Beinachse beeinflusst. Wir untersuchten die Sicherheit und Präzision eines intraoperativ angewandten, computergestützten Navigationssystems. Primärer Endpunkt der Untersuchung war eine enge Korrelation zwischen radiologisch und navigiert ermittelter Beinachse. Methode: Zwischen 1/2004 und 8/2006 wurden 40 Kniegelenke bei 39 Patienten (27 Männer, 12 Frauen), mit Varusgonarthrose computernavigiert valgisiert und prospektiv untersucht. Das Durchschnittsalter betrug 46,3 Jahre (26 - 64 Jahre), das Durchschnittsgewicht betrug 83,2 kg (54 - 118 kg). Ergebnisse: Die klinische und radiologische Nachuntersuchung erfolgte 2 Tage und 3 Monate (Ganzbeinstandaufnahme) postoperativ. Es zeigte sich eine gute Korrelation zwischen radiologisch und navigiert ermittelter mechanischer Beinachse (präoperativ, 8,0 ± 2,5° Röntgen; 7,8 ± 2,1° navigiert; Varus). Die postoperativen Werte zeigen eine breitere Streuung (postoperativ, 0,6 ± 3,2° Röntgen; - 0,7 ± 1,0° navigiert; Valgus). 2 Korrekturverluste traten auf und mussten operativ behandelt werden. Schlussfolgerung: Die aufklappende hohe Tibiakopfosteotomie ist mit verbesserten OP-Techniken und winkelstabilen Implantaten zu einem etablierten Therapieverfahren der Varusgonarthrose geworden. Sie kann in ihrer Präzision und Sicherheit durch computergestützte Navigation verbessert werden.
Abstract
Aim: The open-wedge high tibial osteotomy is an established procedure for the treatment of the unicompartimental gonarthrosis in young patients. An adequate correction of osseous malalignment is crucial for a sufficient reduction of stress in a diseased compartment. We have examined reliability and precision of an intraoperatively used computer-assisted navigation system for high tibial osteotomy. The aim of the study is to show the equivalent safety and effectiveness of high tibial osteotomies carried out with the computer-assisted navigation system. It is assumed that a good correlation between the mechanical tibio-femoral axis as measured by radiography and by the navigation system can be achieved. Method: 40 medial open-wedge osteotomies were performed with computer-assisted navigation on 39 patients (27 males, 12 females) between 1/2004 and 8/2006. The average age was 46.3 years (range: 26 - 64 years), the average weight was 83.2 kg (range: 54 - 118 kg). Results: A good correlation between radiographic data and the data acquired with the navigation system was found for the tibio-femoral axis: preoperative data (8.0 ± 2.5°, radiographic; 7.8 ± 2.1° navigated) for varus alignment. The postoperative correlation was lower than the preoperative one (postoperative data (0.6 ± 3.2° radiographic; - 0.7 ± 1.0° navigated) for valgus alignment. In 2 patients a loss of correction occurred and had to be treated operatively. Conclusion: High tibial osteotomy is an established therapy procedure for unicompartmental gonarthrosis. It can be improved in its precision and reliability by computer-assisted navigation.
Schlüsselwörter
Navigation - Gonarthrose - aufklappende Umstellungsosteotomie - winkelstabile Osteosynthese
Key words
computer‐assisted orthopaedic surgery - gonarthrosis - open wedge osteotomy - rigid internal fixation
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Dr. med. Rainer Wiehe
Orthopädie/Traumatologie
Sportklinik Stuttgart
Taubenheimstraße 8
70372 Stuttgart
Phone: 07 11/5 53 53 25
Fax: 07 11/5 53 51 20
Email: wiehe.rainer@sportklinik-stuttgart.de