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

作　　者：徐会法 崔海峰 汤国良[3] 刘峙辰 赵志刚 第五维龙 范宗峙 黄鲁豫 XU Hui-fa;CUI Hai-feng;TANG Guo-liang;LIU Zhi-chen;ZHAO Zhi-gang;DIWU Wei-long;FAN Zong-zhi;HUANG Lu-yu(Department of Orthopaedics,The First Affiliated Hospital,Air Force Military Medical University,Xi'an 710032,China;The 964^(th)Hospital,Joint Logistic Support Force of PLA,Changchun 130062,China;Department of Traumatic Orthopaedics,The 951^(st)Hospital,Joint Logistic Support Force of PLA,Korla 841007,China)

机构地区：[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

出　　处：《中国矫形外科杂志》2024年第10期932-935,共4页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81171735)。

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(mechanical 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。[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 

分 类 号：R687[医药卫生—骨科学]