股骨远端楔形截骨结合锁定接骨板固定治疗膝外翻畸形  

Femoral supracondylar osteotomy combined with locking compression plate fixation for genu valgum

作　　者：黄德勇[1] 张亮[1] 王达成[1] 张纪[1] 黄野[1] 周一新[1] 

机构地区：[1]北京积水潭医院矫形骨科,北京100035

出　　处：《中国骨与关节外科》2016年第1期22-25,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景：膝关节外翻是较为常见的膝关节周围畸形，临床治疗首选截骨矫形术。目的：探讨股骨远端楔形截骨结合锁定接骨板（locking compression plate, LCP）固定治疗膝外翻畸形的手术技术和有效性。方法：2009年6月至2013年4月行股骨远端楔形截骨结合LCP固定矫正膝外翻畸形47例59膝，男9例11膝，女38例48膝；年龄17-60岁，平均（33.7±5.6）岁。术前9膝存在外侧间室骨关节炎表现，根据Ahlback外侧间室骨关节炎分级标准，6膝为Ⅰ度，3膝为Ⅱ度。手术前后常规拍摄双膝关节负重位正侧位X线片和下肢全长X线片，比较手术前后股骨角和股胫角的变化。临床随访观察截骨角度的变化和骨愈合情况，并对骨关节炎患者的疼痛情况进行评价。结果：所有患者术后膝外翻畸形得到矫正，股骨角由术前45°-78°，平均70.3°±7.3°，矫正至术后75°-90°，平均82.7°±3.7°，矫正8°-35°，平均12.4°±6.6°（P＜0.05）；股胫角由术前130°-169°，平均160.6°±9.1°，矫正至164°-178°，平均173.7°±2.4°，矫正7°-40°，平均13.1°±7.6°（P＜0.05）。本组2例失随访，其余患者获得1.5-6年随访，平均（3.5±0.8）年。45例57膝末次随访时截骨愈合良好，截骨角度未发生丢失，2膝在术后6个月随访时存在延迟愈合。结论：使用股骨髁上楔形截骨术结合LCP固定治疗膝外翻畸形的手术方法方便快捷，固定效果可靠，是一种安全有效的治疗方法。Background：Genu valgum is a common deformity of knee, and it is usually treated by osteotomy. Objective：To evaluate the safety and efficacy of femoral supracondylar osteotomy in the distal femur combined with locking compression plate （LCP） fixation for genu valgum. Methods：From June 2009 to April 2013, 47 patients with genu valgum （59 knees） un-derwent supracondylar osteotomy combined with LCP fixation in the medial or lateral distal femur. There were 9 males （11 knees） and 38 females （48 knees） with an average age of （33.7 ±5.6） years （range, 17-60 years）. Lateral compartment osteo-arthritis was found in 9 knees before surgery.According to Ahlback osteoarthritis staging system, there were 6 knees on stageⅠ, and 3 knees on stageⅡ. The weight bearing AP and lateral view of the knee and the full-length AP view of the lower ex-tremity were obtained before and after operation, and the femoral angle and the femoral-tibial angle were evaluated. After operation the patients were followed-up regularly and bone union and the change of the correction angles as well as the pain of the knees were evaluated. Results：The deformities were well corrected in all cases. The average preoperative and postop-erative lateral distal femoral angles were 70.3°±7.3° （range, 45°-78°） and 82.7°±3.7° （range, 75°-90°）, respectively, with an average improvement of 12.4° ± 6.6° （range, 8°-35° ）. The average preoperative and postoperative femoral-tibial angle were 160.6° ± 9.1° （range, 130°-169° ） and 173.7° ± 2.4° （range, 164°-178° ）, respectively, with an average improvement of 13.1° ± 7.6° （range, 7°-40°） （P〈0.05）. Follow-up was lost in 2 cases. The mean follow-up duration was （3.5±0.8） years （range, 1.5-6 years） in other patients. Delayed bone union was found in 2 knees 6 months postoperatively. The other knees had good re-sults. Conclusions：The femoral supracondylar wedge osteotomy in the distal femur and LCP fixation is a safe and r

关 键 词：膝外翻 截骨术 

分 类 号：R687.3[医药卫生—骨科学]