The Medial Opening Wedge Osteotomy in Which The Tibial Tubercle Remains Attached to the Proximal Fragment: An Anatomıc Study

Yıl 2005, Cilt: 12 Sayı: 3, 153 - 157, 01.06.2005

İrfan Esenkaya Nurzat Elmalı Mesut Mısırlıoğlu Kadir Ertem Alper Atasever

Öz

Objectives: Aim of this study is to perform and to evaluate the medial opening wedge osteotomy technique in which the tibial tubercle remains attached to the proximal fragment of osteotomy on plastic tibial models and human cadaveric and amputated tibiae. Material and Methods: The medial opening wedge osteotomy in which the tibial tubercle (tuberositas tibiae, tibial tuberosity), the area of insertion of the patellar ligament, remains attached to the proximal fragment were applied on 10 plastic tibial models and six human cadaveric and four amputated tibiae. The level of the osteotomy was planned which should be started 4 centimeters distal to the medial joint line and obliquely directed laterally and proximally 1.5 centimeters distal to the lateral joint line and 1 centimeter medial to the lateral cortex. Medial cortex, anterior cortex around the tibial tubercle and posterior cortex were cut in which the tibial tubercle remains attached to the proximal fragment Results: When the medial opening wedge osteotomy in which the tibial tubercle remains attached to the proximal fragment was carried out at human cadaveric tibiae, fracture of tibial tubercle was observed in the first application. The reason of this complication was determined that not to have been noticed posterior angulation of proximal tibia metaphyseal region during the drilling to weaken the bone and later to cut the bone from medial to lateral. We didn't have another fracture in the other bone specimens which was cut 120°-125° angulated anterior cut around and behind the tuberosity. Conclusıons: Distal tuberosity osteotomy in open wedge proximal osteotomy can prevent patella infera because of the patellar ligament and its insertion area tibial tubercle were not exposed to the stretching. Application of these osteotomies on human cadaver or amputated tibiae and plastic tibial models were also diffucult than other classic osteotomy techniques. It must remember that tibial tubercle may be broken during the application of the technique. Key words: Proximal Tibial Osteotomy, High Tibial Osteotomy, Retrotubercle Osteotomy, Patella İnfera, Patella Baja, Anatomic Experiment

Anahtar Kelimeler

Proximal Tibial Osteotomy, High Tibial Osteotomy, Retrotubercle Osteotomy, Patella İnfera, Patella Baja, Anatomic Experiment

Tibial Tüberkülün Proksimal Fragmanda Bırakıldığı Proksimal Tibia Medial Açık Kama Osteotomisi: Anatomik Çalışma+

Öz

Amaç: Proksimal tibia medial açık kama osteotomisinde tibial tüberkülün proksimal fragmanda bırakıldığı retrotüberkül osteotomi tekniğini plastik tibia örnekleriyle insan kadavra ve amputat tibialarında uygulamak ve değerlendirmek. Gereç ve Yöntem: 10 plastik tibia örneğiyle altı insan kadavra ve dört amputat tibiasında, patellar tendonun yapıştığı tibial tüberkül (tuberositas tibia) proksimal fragmanda kalacak şekilde proksimal tibia medial açık kama osteotomisi uygulandı. Medialden açık kama osteotomisi eklem seviyesinin 4 cm distalinden başlayarak lateralde eklem seviyesinin 1.5 cm distaline ve lateral korteksin 1 cm medialine uzanacak şekilde planlandı. Tibial tüberkül geniş bir tabanla proksimal fragmanda kalacak şekilde medial korteks, tibial tüberkül etrafından anterior korteks ve posterior korteks kesildi. Sonuçlar: Tibial tüberkül etrafından yapılan osteotomilerde insan kadavrasına ait tibia örneklerinde ilk uygulamada tibial tükerkül kırıldı. Bu komplikasyon, medialden laterale kemiği zayıflatmak için yapılan drilizasyon ve sonrası osteotomi esnasında proksimal tibia metafizer bölgesinin posteriora yaptığı eğimi hesaplamama sonrası oluştuğu saptandı. Bu eğim göz önüne alınarak yapılan ve tibial tüberkülün proksimal fragmana geniş bir tabanla tutunduğu ve yaklaşık 120-125 derecelik bir açıyla kesildiği örneklerde benzer komplikasyonla karşılaşılmadı. Çıkarımlar: Tibial tüberkülün proksimal fragmanda bırakıdığı medial açık kama osteotomilerinde patellar tendon ve yapışma yeri gerilmeye maruz kalmayacağı için patella infera oluşumu önlenecektir. Ancak, özellikle tibial tüberkül etrafından yapılan osteotomi uygulamasının klasik açık kama osteotomi yöntemlerine kıyasla teknik zorluklar içerdiği ve uygulama esnasında tibial tüberkülün kırılabileceği hatırlanmalıdır. Anahtar kelimeler: Proksimal tibial osteotomi, Yüksek tibial osteotomi, Tuberositas tibia arkasından yapılan osteotomi, Patella/Patellar tendon Oranının azalması, Anatomik çalışma

Anahtar Kelimeler

Proksimal tibial osteotomi, Yüksek tibial osteotomi, Tuberositas tibia arkasından yapılan osteotomi, Patella/Patellar tendon Oranının azalması, Anatomik çalışma

Kaynakça

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