Sinus Tendinoscopies, LINTZ

publicité
Voie Latérale
Arthroscopique du Sinus
Tarsien
Tendinoscopies
AFCP
http://www.afcp.com.fr
DIU
Chirurgie de la Cheville et
du Pied
Séminaire
Bordeaux-Toulouse-Montpellier
Dr F.Lintz
Clinique de l’Union, Saint Jean.
Arthroscopie Sous Talienne
Voie Latérale
Historique
›  Arthroscopie
sous-talienne:
Parisien&Vangsness (1985)
›  Voie latérale x 3
›  Arthrodèse
›  Voie
postérieure x 2 (N.Van Dijk)
Orthopedics. 2009 Dec;32(12):891. doi: 10.3928/01477447-20091020-12.
Subtalar arthroscopic procedures for the treatment of subtalar pathologic conditions: 115
consecutive cases.
Ahn JH1, Lee SK, Kim KJ, Kim YI, Choy WS.
• 
115 patients, 40 ans, FU 3 ans ½.
• 
• 
31 sd sinus tarsien
30 arthroses
• 
• 
• 
• 
• 
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15 fractures calca
10 arthrofibroses
8 os trigones
7 coalitions tarsiennes
5 fract talus
1 kyste essentiel du calca
31 synovites – synovectomie
26 arthrodèses
20 debridement-arthoplastie
8 ablation d’os trigone
6 chondromalacie –shaving
11 corps etrangers
AOFAS 33-84 (gpe arthrodèse)
AOFAS 69-89 (gpe non arthrodèse)
World J Orthop. 2015 Jan 18;6(1):56-61. doi: 10.5312/wjo.v6.i1.56. eCollection 2015 Jan 18. Review.
Subtalar arthroscopy: When, why and how.
Lui TH, Tong SC. Free PMC Article
›  Fractures
Calca
›  Synthèse
›  Séquelles
›  Impingment
calcaneo-fibulaire
›  Arthrofibrose sous talienne
›  Arthrodèse
sous talienne
Voie latérale
3 voies
›  Sinus Tarisen
›  Voie
antérieure
›  Voie moyenne
›  Voie
Anterior
postéro-latérale
Middle
Posterior
Cronier P, Steiger V, Talha A, Sourice S, Grandpierre J.
Vascularisation artérielle du talus, conséquences chirurgicales. In:
Besse JL, Leemrijse T, Maestro M, eds. Monographie AFCP N° 5,
Journée de spécialité SOFCOT 2009. Montpellier: Sauramps
Medical, 2009; 169-176.
Littérature
› 
(1) Mouilhade (voie postérieur NVD) :
› 
› 
› 
% Fusion = Arthrodèse ?
› 
› 
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Avivement: 97,5 %
Nf sural: 1/10
(2) Thaunat 33%
(3) Ahn 60%
Vascularisation (4)
1-Mouilhade F, Oger P, Roussignol X, et al. Risks relating to posterior 2-portal arthroscopic subtalar arthrodesis and articular surfaces abrasion quality
achievable with these approaches: a cadaver study. Orthop Traumatol Surg Res 2011; 97(4): 396-400.
2-Thaunat M, Bajard X, Boisrenoult P, Beaufils P, Oger P. Computer Tomography assessment of the fusion rate after posterior arthroscopic subtalar
arthrodesis. Int Orthop 2012; 36(5): 1005-10.
3-Ahn JH, Lee SK, Kim KJ, Kim YI, Choy WS. Subtalar arthroscopic procedures for the treatment of subtalar pathologic conditions: 115 consecutive cases.
Orthopedics 2009; 32(12): 891
4- Kelly PJ ,Sullivan CR. Blood supply of the talus. Clin Orthop Relat Res 1963; 30: 37-44.
› 
Placement des voies
› 
› 
M
A
› 
Axe longitudinal
fibula
› 
Equateur Sinus Tarse
› 
Innocuité
anatomique
› 
Qualité de la
résection
Arthroscopy. 2013 Jul;29(7):1217-23. doi: 10.1016/j.arthro.2013.04.016.
Safety and efficiency of a 2-portal lateral approach to arthroscopic subtalar
arthrodesis: a cadaveric study.
Lintz F, Guillard C, Colin F, Marchand JB, Brilhault J.
Avivement
91 % Surface CALCA
94 % Surface TALUS
Fusion 83,5 ±4,8%
Tendinoscopie des fibulaires
›  Indications:
›  Tenosynovectomie
›  Sous
talienne post
›  Conflit tubercule fibulaires
›  Ligamentoplastie, temps CFL
›  Instabilité des fibulaires
Dangers
7-8 cm
3cm
›  Nerf
Sural
›  Vincula
Installation
•  Latéral
•  Pied Pendant
Voie d’abord
•  Voie Proximale
•  Abord Gaine
•  Dissection
Tendinoscopie du tibial
posterieur
1.
Functional Outcomes of Tibialis Posterior Tendoscopy With Comparison to Magnetic Resonance Imaging.
Gianakos AL, Ross KA, Hannon CP, Duke GL, Prado MP, Kennedy JG.
Foot Ankle Int. 2015 Jul;36(7):812-9. doi: 10.1177/1071100715576485. Epub 2015 Mar 10.
2.
Endoscopic adhesiolysis for extensive tibialis posterior tendon and Achilles tendon adhesions following compound tendon
rupture.
Lui TH.
BMJ Case Rep. 2013 Sep 17;2013. pii: bcr2013200824. doi: 10.1136/bcr-2013-200824.
•  Tenosynovectomie
•  Adhésiolyse
•  Diagnostic
•  12 cas, niveau 4, FAOS: 58-81, SF-12: 34-5, FU 2ans1/2
Littérature
› 
› 
› 
Foot Ankle Int. 2011 Feb;32(2):189-92. doi: 10.3113/FAI.
2011.0189.
Validity of the posterior tibial edema sign in posterior tibial
tendon dysfunction.
DeOrio JK1, Shapiro SA, McNeil RB, Stansel J.
› 
Sensibilité 86%, Spécificité 100% / I.R.M.
Infiltration ?
Foot Ankle. 1992 Feb;13(2):70-9.
Possible epidemiological factors associated with rupture of the posterior tibial
tendon.
Holmes GB Jr1, Mann RA.
› 
› 
Tendon rupture AND steroid injection
›  126 résultats
›  Achille +++, Tendon patellaire, Main
J Orthop Res. 2014 Oct;32(10):1297-304. doi: 10.1002/jor.22681. Epub 2014
Jul 2.
Temporary inductions of matrix metalloprotease-3 (MMP-3) expression and
cell apoptosis are associated with tendon degeneration or rupture after
corticosteroid injection.
Muto T1, Kokubu T, Mifune Y, Inui A, Harada Y, Yoshifumi, Takase F, Kuroda R,
Kurosaka M.
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At 1 week, the biomechanical strength was significantly lower in the
corticosteroid groups. Histological analysis, at 1-week post-injection,
showed collagen attenuation, increased expression of MMP-3 and
apoptotic cells in the corticosteroid groups.
ANATOMY SPRING LIGAMENT
Technique chirurgicale
Repères cutanés
Voies d’abord
Appareillage +++
MERCI
›  [email protected]
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