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Öz

Amaç: Bu çalışmanın amacı talusun medialindeki osteokondral lezyonlarının mozaikplasti ile tedavisi sırasında tercih ettiğimiz Chevron osteotomisinin orta dönem sonuçlarını değerlendirerek cerrahiye katkısını ve osteotomi alanında oluşabilecek komplikasyonları azaltıp azaltmadığını radyolojik olarak değerlendirmektir.Çalışma planı: Mozaikplasti sırasında Chevron tipi medial malleol osteotomisi yapılan ve takip süresi iki yıldan uzun olan 42 hasta (31 erkek, 11 kadın) çalışmaya alındı. Ortalama yaş 34 (dağılım 18–54) yıldı. Preoperatif dönemde MRI üzerinden lezyonun boyutları koronal ve sagital planda milimetre (mm) cinsinden ölçüldü. Postoperatif grafiler üzerinden osteotominin koronal planda tibia uzun aksı ile yaptığı açı, sagital planda kollar arasındaki açı ve vidaların osteotomi hattına gönderilme açısı ölçüldü. Son kontrol sırasında çekilen grafilerde kaynamama, yanlış kaynama ve vidalara bağlı komplikasyonlar değerlendirildi.Bulgular: Hastaların ortalama takip süresi 31,4 aydı. Son kontrol grafilerinde distraksiyon, distal parçada migrasyon veya rotasyon gözlenmedi. Sadece bir hastada radyolojik kaynamama vardı. Ortalama kaynama süresi 5,8 haftaydı. 8 hastanın vidaları ortalama 7.4 ayda çıkarıldı. Osteotomi hattının tibianın uzun ekseni ile olan ortalama açısı 29,0°±6,5°, koronal planda osteotomi kolları arasındaki açı 74,7°±8,3° ve vidaların koronal planda gönderilme açısı 85,7°±5,9° olarak bulundu.Çıkarımlar: Chevron osteotomisi, talus medialinde bulunan osteokondral lezyonların tedavisi için kullanılan güvenli bir yardımcı cerrahi yöntem olmakla birlikte ve geometrisi sayesinde etkin bir tespite izin verdiği için hızlı ve anatomik iyileşmeyi sağlayan bir yöntemdir

Anahtar Kelimeler

• Malleol; osteotomi; osteokondral lezyon; talus; ters Chevron

Chevron osteotomy in patients with scheduled osteotomy of the medial malleolus

Abstract

Objective: The aim of the present study was to evaluate intermediate-term outcomes of Chevron osteotomy for treatment of osteochondral lesions of the talus with mosaicplasty and to assess its effect on surgery and whether it reduces complications that might occur intraoperatively.
Methods: The present study included a total of 42 patients (31 men and 11 women) who underwent Chevron osteotomy of the medial malleolus and who had been followed for more than 2 years. Mean age of the patients was 34 years (range: 18–54 years). Preoperatively, size of the lesions was measured in millimeters in the coronal and sagittal planes using magnetic resonance imaging (MRI). The angle between the osteotomy with the long axis of the tibia was measured on the coronal plane, the angle between the arms and the angle for the screws to be directed to the osteotomy line were measured on the sagittal plane on the postoperative images. Nonunion, malunion, and complications from the screws were evaluated from X-ray images taken at the final follow-up.
Results: Mean duration for follow-up was 31.4 years (range: 24–46). On the X-ray images taken at the final follow-up, no distraction, migration of the distal part, or rotation was observed. Only 1 patient experienced radiological non-union. Mean duration to union was 5.8 weeks (range: 4–14 weeks). Screws of 8 patients were removed at an average of 7.4 months (range: 5–11 months). The angle between the osteotomy line and long axis of the tibia was 29.0°±6.5°, the angel between the osteotomy arms on the sagittal plane was 74.7°±8.3°, and the direction angle of the screws on the coronal plane was 85.7°±5.9°.
Conclusion: Chevron osteotomy is an assistive surgical method used for treatment of osteochondral lesions located in the medial talar joint surface (TOL) which provides fast anatomical healing because it allows efficient fixation due to its geometry.

Keywords

• Inverted Chevron
• malleolus
• osteochondral lesions of talus
• osteotomy
• talus

Kaynakça

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