摘要
目的：通过回顾性研究，评价使用锁定钢板固定的股骨远端内侧髁上闭合楔形不全截骨技术治疗膝外翻的安全性和有效性。方法从2011年8月至2013年2月，共26例膝外翻患者（37膝）接受了股骨髁上内侧闭合楔形不全截骨术，并用 Tomofix 股骨远端内侧锁定钢板固定。患者平均年龄25.6（18～37）岁。膝关节外侧单间室骨关节炎均为Ahlback I期。结果平均随访23.6（13～31）个月。股胫角术前160.2（152～167）°，术后175.6（171～178）°，平均改善14.4（6～22）°；远端股骨外侧角术前股骨角术前68.4（60～74）°，术后82.3（77～84）°，平均改善13.9（7～21）°。差异均有统计学意义（ P＜0.05）。美国特种外科医院HSS膝关节功能评分从术前平均91.7（77～98）分改善至术后平均97.8（84～100）分，但差异无统计学意义（ P＞0.05）。37膝中有2膝出现延迟愈合，均与骨性合页断裂移位有关。1例因出现术后血肿再次手术，2例对术后下肢力线过矫不满，无感染和骨折不愈合发生。结论采用股骨远端内侧闭合楔形不全截骨技术与锁定钢板固定，可以有效地纠正膝外翻，方法安全可靠，截骨时保留外侧骨性和软组织合页是骨折迅速愈合的关键。
Objective To evaluate the safety and efifcacy of incomplete supracondylar medial closing wedge osteotomy in the distal femur and locking compression plate （ LCP ） ifxation for genu valgum in a retrospective study. Methods From August 2011 to February 2013, 26 patients with genu valgum （ 37 knees ） underwent incomplete supracondylar closing wedge osteotomy and Tomoifx plate ifxation in the medial distal femur, whose mean age was 25.6 years old （ range： 18-37 years ）. Lateral compartment osteoarthritis of the knee was classiifed as Ahlb？ck I stage. Results The mean follow-up duration was 23.6 months （ range： 13-31 months ）. The preoperative and postoperative femoro-tibial angles were 160.2° （ 152-167 ） ° and 175.6° （ 171-178 ） ° respectively, with an average improvement of 14.4° （ 6-22 ） °. The preoperative and postoperative lateral distal femoral angles were 68.4° （ 60-74 ） ° and 82.3° （ 77-84 ） ° respectively, with an average improvement of 13.9° （ 7-21 ） °. The differences between the preoperative and postoperative angles were statistically signiifcant （P〈0.05 ）. The Hospital for Special Surgery （ HSS ） knee score was improved from 91.7 points （ range： 77-98 points ） preoperatively to 97.8 points （ range： 84-100 points ） postoperatively, with no statistically signiifcant differences （P＆gt;0.05 ）. Delayed bone union was found in 2 of the 37 knees, which was related to the breakage and displacement of bone hinges. Reoperation was performed on 1 patient due to postoperative hematomas. Two patients were unsatisfied with the appearance of the lower limbs because of the alignment overcorrection. No non-union or infection was noticed.Conclusions The technique of incomplete supracondylar medial closing wedge osteotomy in the distal femur and LCP ifxation is safe and reliable, which can effectively correct genu valgum. The preservation of lateral bone and soft tissue hinges is the key of early bone healing.
出处
《中国骨与关节杂志》
CAS
2014年第7期531-535,共5页
Chinese Journal of Bone and Joint
