股骨远端和胫骨近端联合截骨矫正复杂膝内翻畸形△（开放获取）

Combined distal femur and proximal tibia osteotomy for correction of complex knee varus (Open Access)

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 （mechani- cal 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。

Abstract:

[Objective] To evaluate the reliability and effectiveness of combined high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) in the correction of complex knee varus in adolescents. [Methods] From July 2015 to June 2022, 10 patients (12 knees) underwent combined DFO and HTO osteotomy. The clinical and imaging documents were evaluated. [Results] All the patients had operation performed 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] Combined 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.