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Der Orthopäde

, Volume 34, Issue 6, pp 603–612 | Cite as

Häufigkeit und Schweregrad von Kallusdefekten

Dorsomedialer vs. ventrolateraler Zugangsweg für die Kortikotomie bei der Tibiakallusdistraktion
  • C. HeissEmail author
  • S. A. Meissner
  • C. Meyer
  • J. Pfeil
  • R. Schnettler
Originalien

Zusammenfassung

Hintergrund

Ziel dieser Arbeit war der Vergleich eines dorsomedialen mit dem ventrolateralen Zugangsweg zur proximalen metaphysären Tibia für die Kortikotomie bei Kallusdistraktionen.

Patienten und Methoden

Bei 28 Patienten wurden 31 Kallusdistraktionen durchgeführt. Dabei erfolgten 18 Kortikotomien über den ventrolateralen, 13 über den dorsomedialen Zugangsweg. Die Kallusdefekte wurden nach ihrer Ausdehnung anhand von Röntgenverlaufskontrollen in 4 Schweregrade eingeteilt. Aus den Defekten vom Grad 3 und 4 wurden Biopsien entnommen.

Ergebnisse

Es zeigten sich 13 Defekte, von denen 12 nach Anwendung des ventrolateralen Zugangs auftraten. Die 7 Defekte vom Grad 1 und 2 heilten spontan aus, während bei den 6 Defekten vom Grad 3 und 4, in denen sich histologisch keine Osteogenese zeigte, eine Spongiosaplastik notwendig war.

Schlussfolgerung

Zur Vermeidung von Kallusdefekten und im Sinne einer physiologischen Osteogenese erscheint ein minimal-invasiver dorsomedialer Zugangsweg bei der Kallusdistraktion an der proximalen Tibia günstig.

Schlüsselwörter

Kallusdefekt Kallusdistraktion Operativer Zugang Gefäßversorgung Osteogenese 

Frequency and severity of callus defects

Dorsomedial vs ventrolateral approach for corticotomy in performing callus distraction of the tibia

Abstract

Background

The purpose of this study was to compare a dorsomedial to the ventrolateral approach for corticotomy in performing callus distraction of the proximal metaphyseal tibia.

Patients and methods

A total of 31 callus distractions were performed in 28 humans. The ventrolateral approach was used for 18 and the dorsomedial approach for 13 corticotomies. A scale of four severity grades was used to classify callus defect zones based on their extent as evidenced on serial X-rays. Biopsies were taken from higher-grade defects (grades 3–4).

Results

A total of 13 radiological evaluations revealed 12 defects using the ventrolateral approach. Seven defects (grades 1–2) healed spontaneously, whereas six defects (grades 3–4) required operative intervention as histological tissue examination showed no osteogenic potential.

Conclusion

To prevent callus defects of the proximal tibia in the future and to ensure maximal osteogenic potential in the distraction zone, a minimally invasive dorsomedial approach appears to achieve favorable results.

Keywords

Callus defect Callus distraction Operative approach Vascular supply Osteogenic potential 

Notes

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  • C. Heiss
    • 1
    • 3
    Email author
  • S. A. Meissner
    • 1
  • C. Meyer
    • 1
  • J. Pfeil
    • 2
  • R. Schnettler
    • 1
  1. 1.Klinik und Poliklinik für UnfallchirurgieJustus-Liebig-UniversitätGießen
  2. 2.Orthopädische KlinikSt.-Josefs-HospitalWiesbaden
  3. 3.Klinik und Poliklinik für UnfallchirurgieJustus-Liebig-UniversitätGießen

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