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Navigierte Korrekturarthrodese des unteren Sprunggelenks

Computer-Assisted Surgery-(CAS-)Guided Correction Arthrodesis of the Subtalar Joint

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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Wiederherstellung eines plantigraden, belastbaren Fußes bei Deformitäten am Rückfuß und gleichzeitigen degenerativen Veränderungen am unteren Sprunggelenk (USG).

Indikationen

Arthrose des USG und Fehlstellung des Rückfußes.

Kontraindikationen

Floride Infektionen am Rückfuß oder schwere Durchblutungsstörung.

Operationstechnik

Bauchlage und posterolateraler Zugang zum Subtalargelenk. Platzierung der dynamischen Referenzbasen in Talus und Kalkaneus über Stichinzisionen. Zweidimensionale Bildakquisition zur Navigation. Festlegung der Achsen von Talus und Kalkaneus, die im Verhältnis zueinander navigiert werden. Festlegung des Korrekturausmaßes anhand der präoperativen Planung. Darstellung des Subtalargelenks und Entknorpelung. Navigationsgestützte Stellungskorrektur und Transfixation des Korrekturergebnisses mit zwei 2,5-mm-Kirschner-Drähten. Transplantation von autologer Spongiosa und, wenn nötig, kortikalem Knochen in das Subtalargelenk. Dreidimensionale (3-D) Bildakquisition zur Analyse der Korrekturgenauigkeit und zur Planung der Bohrungen für die Schraubeninsertion. Navigierter Bohrvorgang und Einbringen der Schrauben. 3-D-Scan zur Kontrolle der Rückfußstellung und Implantatlage. Bei korrekter Position Einlage einer Drainage und schichtweiser Wundverschluss.

Weiterbehandlung

6-wöchige Teilbelastung mit 15 kg in einer Orthese (z.B. Vacuped, OPED GmbH, Valley). Danach Übergang zur Vollbelastung im festen Konfektionsschuh.

Ergebnisse

Vom 01.09.2006 bis 31.08.2008 wurden 26 Korrekturarthrodesen durchgeführt. Die Analyse der Genauigkeit durch Vergleich der im präoperativen Computertomogramm geplanten Korrektur und der im intraoperativen ARCADIS-3D-Scan gemessenen erreichten Korrektur zeigt eine Abweichung von maximal 2° oder 2 mm. Navigationsassoziierte Komplikationen wurden nicht beobachtet. In den bisher nach 2 Jahren nachuntersuchten 25 Fällen trat eine zeitgerechte Durchbauung ein.

Abstract

Objective

Restoration of a stable and plantigrade foot in deformities at the hindfoot and concomitant degenerative changes at the subtalar joint.

Indications

Deformities at the hindfoot and concomitant degenerative changes at the subtalar joint.

Contraindications

Active local infection or relevant vascular insufficiency.

Surgical Technique

Prone position and posterolateral approach to the subtalar joint. Placement of dynamic reference bases in talus and calcaneus through stab incisions. Two-dimensional image acquisition for navigation. Definition of the axes of talus and calcaneus, and of the extent of correction. Exposure of the subtalar joint and removal of remaining cartilage. Computer- assisted surgery-(CAS-)guided correction and transfixation of the corrected position with two 2.5-mm Kirschner wires. Transplantation of autologous cancellous and cortical bone, if necessary. Three-dimensional (3-D) image acquisition for analysis of the accuracy of the correction and planning of the drillings for the screws. CAS-guided drilling and insertion of the screws. 3-D image acquisition for analysis of the accuracy of the correction implant position. Wound closure in layers.

Postoperative Management

15 kg partial weight bearing in an orthosis (e.g. Vacuped TM, OPED Inc., Valley, Germany) for 6 weeks, followed by full weight bearing in a stable standard shoe.

Results

From September 1, 2006 to August 31, 2008, 26 correction arthrodeses were performed. The accuracy was assessed by intraoperative 3-D imaging. All achieved angles/translations were within a maximum deviation of 2°/2 mm when compared to the planned correction. Complications that were associated with CAS were not observed. In all 25 cases that completed 2-year follow-up, timely fusion was registered.

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Authors and Affiliations

  1. II. Chirurgische Klinik (Unfallchirurgie, Orthopädie und Fußchirurgie), Klinikum Coburg, Coburg, Germany

    Martinus Richter

  2. II. Chirurgische Klinik (Unfallchirurgie, Orthopädie und Fußchirurgie), Klinikum Coburg, Ketschendorfer Straße 33, 96450, Coburg, Germany

    Martinus Richter

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Correspondence to Martinus Richter.

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Zeichner: Rüdiger Himmelhan, Heidelberg

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Richter, M. Navigierte Korrekturarthrodese des unteren Sprunggelenks. Orthop Traumatol 22, 402–413 (2010). https://doi.org/10.1007/s00064-010-8069-y

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