BACKGROUND In highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief. However, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy is a type of joint preservation surgery that has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator for treating ankle osteoarthritis. METHODS A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed, followed by angled osteotomy and correction of the distal tibia; the ankle joint was then stabilized after its condition improved. An external fixator was used in all patients, and joint distraction of approximately 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. RESULTS The anteroposterior and lateral mortise angle during weight-bearing, talar tilt angle, and anterior translation of the talus on ankle stress radiography were improved significantly (P < 0.05). Signal changes on magnetic resonance imaging also improved in all patients. Visual analog scale and American Orthopedic Foot & Ankle Society scores improved significantly (P < 0.05), and no severe complications were observed. CONCLUSION DTO with joint distraction may be useful as a joint-preserving surgery for medial ankle osteoarthritis in older patients with high levels of physical activity. LEVEL OF EVIDENCE Level IV, retrospective case series.

中文翻译：

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远端胫骨截骨术与牵引置换术治疗内翻性踝骨关节炎。

背景技术在活跃度较高的老年人中，传统上已使用胫bio距关节固定术治疗了终末期踝骨关节炎，这可显着缓解疼痛。但是，脚踝关节运动会丢失，并且未来在相邻关节中存在关节炎的风险。牵引置换术是一种简单的方法，可以修复关节软骨。但是，目前的结果好坏参半，有些报告显示疼痛评分得到改善，而另一些报告则没有改善。胫骨远端截骨术（DTO）无腓骨截骨术是一种关节保留手术，近年来已引起广泛关注。然而，据我们所知，尚无关于使用圆形外固定器进行关节牵引的DTO的报道。因此，本研究的目的是研究使用圆形外固定器治疗踝关节骨关节炎的关节牵引术对DTO的影响。方法对21例踝关节内侧关节炎患者进行检查。进行关节镜滑膜切除术和微骨折手术，然后进行成角度的截骨术和胫骨远端矫正。病情好转后，踝关节得以稳定。所有患者均使用外固定架，并进行约5.8 mm的关节牵开。手术后立即允许所有患者完全负重行走。结果在踝关节应力放射照相时，负重过程中的前后榫角，距骨倾斜角和距骨前移均得到了显着改善（P <0.05）。所有患者的磁共振成像信号变化也得到改善。视觉模拟量表和美国整形外科足踝学会评分显着改善（P <0.05），并且未观察到严重并发症。结论DTO联合牵引术可作为高强度体育锻炼的老年患者的内侧踝骨关节炎的保留关节手术。证据级别IV级，回顾性案例系列。