外固定架辅助髓内钉治疗膝外翻或膝内翻畸形  

Management of valgus or varus knee deformity with fixator assist nailing technique and distal femur osteotomy

作　　者：杨胜松[1] 黄雷 滕星[1] 王陶[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,北京100035

出　　处：《北京大学学报（医学版）》2016年第2期244-249,共6页Journal of Peking University:Health Sciences

基　　金：首都临床特色应用研究(Z121107001012006)资助~~

摘　　要：目的：探讨股骨远端截骨（distal femur osteotomy,DFO）和外固定架辅助髓内钉（fixator assist nailing,FAN）技术治疗股骨侧膝外翻或膝内翻畸形的效果。方法：回顾性分析2008年1月至2013年12月间采用FAN技术治疗的14例17侧下肢畸形患者,包括12例膝外翻和5例膝内翻畸形。手术方法采用单边外固定架固定股骨,股骨髁上部位微创截骨,矫正畸形后逆行髓内钉固定,所有患者均未植骨。测量患肢术前和术后的股骨远端外侧角（lateral distal femur angle,LDFA）、机械轴偏离度（mechanical axis deviation,MAD）、膝关节活动范围（range of motion,ROM）,并进行分析。结果：14例患者均得到完整随访,随访时间12-72个月,平均34个月。患者截骨端在术后3-5个月（平均3.5个月）愈合。根据Paley功能评分标准,12例为优,2例为良;12例患者的15侧肢体术后MAD在膝关节中心内侧15 mm至外侧10 mm之间,患肢力线得到满意矫正;17侧肢体有11侧LDFA达到正常范围（84°-90°）。没有患者发生感染和神经血管损伤,术后膝关节活动范围同术前无显著差异。结论：FAN技术结合了外固定架安全、微创、便于调节、可准确矫正畸形的优点,以及髓内钉固定时患者依从性高的特点,可有效地治疗年轻患者的股骨侧膝外翻或膝内翻畸形。Objective： To discuss the result of treating valgus or varus knee deformity with fixator assist nailing（ FAN） technique and distal femur osteotomy（ DFO）. Methods： In this retrospective study,14 patients with 17 limbs,12 valgus and 5 varus knee deformity were treated with DFO and FAN. The average age of the patients was 23（ 17- 44） years. The unilateral external fixator was mounted on the lateral side of femur,the minimal invasive distal femoral osteotomy was performed. After the deformity was corrected,the intramedully nail was inserted to fix the femur. None of the patients need bone autograft. The preoperation and postoperation lateral distal femur angle（ LDFA）,mechanical axis deviation（ MAD）and range of motion（ ROM） were measured and analyzed. Results： All the 14 patients were followed-up for 12- 72 months（ average 34 months）. The osteotomy site united in 3- 5 months（ average 3. 5months） post-operatively. According to Paley＇s functional scores,12 patients were excellent,2 patients were good. We achieved desired postoperative MAD（ from medial 15 mm to lateral 10 mm） in 15 limbs of 12 patients. The LDFA in 11 limbs was corrected to normal（ 84°- 90°）. The ROM was not significantly changed before and after operation in the both groups. No infection or neuro-vascular injury occurred. Conclusion： The FAN technique is an effective method to treat valgus knee or varus knee deformity in young patients with DFO.

关 键 词：外固定架 骨钉 关节畸形 获得性 截骨术 

分 类 号：R682.6[医药卫生—骨科学]