股骨远端和胫骨近端联合截骨矫正复杂膝内翻畸形
Combined distal femur and proximal tibia osteotomy for correction of complex knee varus
徐会法 1崔海峰 2汤国良 3刘峙辰 1赵志刚 1第五维龙 1范宗峙 1黄鲁豫1
作者信息
- 1. 空军军医大学第一附属医院骨科,陕西西安 710032
- 2. 解放军联勤保障部队第964医院,吉林长春 130062
- 3. 中国人民解放军第951医院创伤骨科,新疆库尔勒 841007
- 折叠
摘要
[目的]评价胫骨高位截骨(high tibial osteotomy,HTO)和股骨远端截骨(distal femoral osteotomy,DFO)矫正青少年膝关节复杂畸形的可靠性和有效性.[方法]2015年7月-2022年6月10例(12膝)患者接受了 DFO、HTO联合截骨,评价临床及影像结果.[结果]本组病例均顺利完成手术,术中无血管、神经损伤等并发症.10例患者均获得随访,平均随访时间(21.9±10.3)个月.下地行走时间(36.9±18.2)d.与术前相比,末次随访 HSS 评分[(86.6±5.1),(97.2±1.2),P＜0.001]及 Lysholm评分[(77.5±15.3),(95.7±2.7),P＜0.001]均显著增加,VAS 评分[(4.2±1.2),(0.7±0.3),P＜0.001]显著降低.影像方面,与术前相比,术后胫骨近端内侧角(proximal medial tibial angle,MPTA)[(72.3±6.6)°,(85.2±1.9)°,P＜0.001]、股骨远端外侧机械角(mechani-cal lateral distal femoral angle,mLDFA)[(78.2±5.3)°,(87.4±0.9)°,P＜0.001]、股胫角(femorotibial angle,FTA)[(182.8±4.4)°,(176.6±2.1)°,P＜0.001]均显著改善.双下肢长度差[(24.6±6.8)mm,(11.9±4.3)mm,P＜0.001]和机械轴偏移[(30.9±11.3)mm,(10.4±3.8)mm,P＜0.001]显著减少.[结论]DFO、HTO联合截骨有效矫正膝内翻畸形的同时还可以增加患肢长度,短期的随访结果满意.
Abstract
[Objective]To evaluate the reliability and effectiveness of combined high tibial osteotomy(HTO)and distal femoral osteoto-my(DFO)in the correction of complex knee varus in adolescents.[Methods]From July 2015 to June 2022,10 patients(12 knees)under-went combined DFO and HTO osteotomy.The clinical and imaging documents were evaluated.[Results]All the patients had operation per-formed successfully without complications,such as vascular and nerve injury during the operation.All the 10 patients were followed up with an average of(21.9±10.3)months,with walking time of(36.9±18.2)days.Compared with those preoperatively,the HSS score[(86.6±5.1),(97.2±1.2),P＜0.001]and Lysholm score[(77.5±15.3),(95.7±2.7),P＜0.001]significantly increased,whereas VAS scores[(4.2±1.2),(0.7±0.3),P＜0.001]significantly decreased at the last follow-up.As for imaging,the proximal medial tibial angle(MPTA)[(72.3±6.6)°,(85.2±1.9)°,P＜0.001],mechanical lateral distal femoral angle(mLDFA)[(78.2±5.3)°,(87.4±0.9)°,P＜0.001],and femorotibial angle(FTA)[(182.8±4.4)°,(176.6±2.1)°,P＜0.001]significantly improved,additionally,the leg length discrepancy(LLD)[(24.6±6.8)mm,(11.9±4.3)mm,P＜0.001],and the mechanical axis deviation[(30.9±11.3)mm,(10.4±3.8)mm,P＜0.001]significantly declined.[Conclusion]Com-bined DFO and HTO osteotomy do effectively correct the varus deformity of the knee,and increase the length of the affected limb,achieve satisfactory short-term consequence.
关键词
膝内翻畸形/胫骨高位截骨/股骨远端截骨Key words
knee varus deformity/high tibial osteotomy/distal femoral osteotomy引用本文复制引用
出版年
2024
NETL
NSTL
万方数据