顺行性骨搬移术治疗胫骨骨缺损合并膝内翻畸形  

Outcome of realignment for genu varum with tibial bone defect managed with antegrade bone transport

作　　者：滕星 杨胜松 王陶 黄雷 公茂琪 蒋协远 Teng Xing;Yang Shengsong;Wang Tao;Huang Lei;Gong Maoqi;Jiang Xieyuan(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Capital Medical University,the Fourth Clinical Medical College of Peking University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院,北京大学第四临床医学院创伤骨科,北京100035

出　　处：《中华骨科杂志》2023年第18期1215-1222,共8页Chinese Journal of Orthopaedics

基　　金：首都临床特色应用研究与成果推广(Z161100000516052)。

摘　　要：目的探讨采用顺行性骨搬移术治疗胫骨骨缺损合并膝内翻畸形的疗效。方法回顾性分析2012年1月至2020年12月采用顺行性骨搬移术治疗胫骨骨缺损合并膝内翻畸形患者11例,均为男性,年龄(42±16)岁。其中左侧8例、右侧3例;均为骨折术后骨缺损,节段性骨缺损长度为(7.9±2.1)cm;10例为先天性膝内翻、1例为胫骨近段骨折畸形愈合致膝内翻。术前胫骨-股骨解剖轴外侧角为179°(178°,180°),股骨远端解剖轴外侧角为82°(81°,83°),膝关节关节线相交角为0°(0°,1°),胫骨近端解剖轴内侧角为83.1°±3.9°。7例应用单边外固定架、3例应用环形外固定架、1例应用混合式外固定架,采用顺行性骨搬移术治疗骨缺损及内翻畸形。其中3例采用单边外固定架者额外通过摆动夹钳矫正内翻、1例采用环形外固定架者在胫骨近段外侧安装铰链通过延长内侧的螺纹杆矫正内翻。术后测量单边和混合式外固定架近端固定针或环形外固定架的近端环与膝关节面的夹角、下肢机械轴偏向、下肢机械轴通过胫骨平台关节面的位置、胫骨近端机械轴内侧角、畸形矫正的角度、骨愈合时间、骨愈合指数、Paley的功能评分及并发症种类。结果11例患者均获得随访,拆除外固定架后的随访时间为11(3,25)个月。7例采用单边外固定架和1例采用混合式外固定架者近端固定针与关节面的夹角为0°(-1°,1°),3例采用环形外固定架者近端固定环和关节面的夹角分别为0°、0°、2°。治疗结束时,下肢机械轴偏向(-6±6)mm、下肢机械轴经过胫骨平台的58%±9%、胫骨近端机械轴内侧角为90°(89°,92°)、矫正角度为7.2°±3.9°。治疗后所有患者骨缺损均达到骨性愈合,骨愈合时间为(12±4)个月(范围7~20个月),骨愈合指数(1.6±0.6)个月/cm(范围1.2~2.9个月/cm);Paley功能评分结果为优7例和良4例。其中3例针道感染和2例软组织感染口服抗生素达�Objective To study the outcome of realignment for genu varum with tibial bone defect managed with antegrade bone transport.Methods To retrospectively study 1l patients with tibial bone defect and genu varum treated with antegrade bone transport from January 2012 to December 2020.All the patients were males,aged 42±16 years,left in 8 cases and right in 3.The segmental bone defect was secondary to fractures with amount of 7.9±2.1 cm.10 cases were congenital genu varus,and 1 case was genu varus caused by malunion of proximal tibial fracture.The anatomical lateral tibio-femoral angle(aLTFA)was 179°(178°,180°),the anatomical lateral distal femoral angle(aLDFA)was 82°(81°,83°),joint line convergence angle(JLCA)was 0°(0°,1°)and the anatomical medial proximal tibial angle(aMPTA)was 83.1°±3.9°before treatment.7 cases were treated with unilateral external fixators,3 cases with circular external fixators,and 1 case with hybrid external fixator.Antegrade bone transport surgeries were performed to treat bone defects and varus deformities.Among them,3 cases using unilateral external fixators were additionally corrected for varus using swinging clamps,while 1 case using a circular external fixator was corrected for varus by installing hinges on the lateral side of the proximal tibia and distracting the medial-positioned threaded rod.The data including the angles between proximal pins in monorail fixators or proximal ring orientation in ring fixators and knee joint line,post-operative mechanic axis deviation(MAD)of lower extremity,the position of the mechanical axis relative to the width of the tibial plateau,mechanic medial proximal tibial angle(mMPTA),the amount of deformity correction in radiographic AP view,bone healing time,bone healing index(BHI),functional score and complications according to Paley's criteria were studied.Results All 1l patients were followed up,and the follow-up time after removing the external fixators was 11(3,25)months.The angles between pins in proximal clamp in monorail frame of 7 case

关 键 词：胫骨 膝内翻 伊利扎罗夫技术 骨缺损 

分 类 号：R687.3[医药卫生—骨科学]