股骨髁上后倾角截骨术远期并发症原因探讨

The Long-term Results Following Supracondylar Osteotomy of the Femur:A Report of 358 Cases

作者通过对股骨髁上后倾角截骨术（以下简称后倾角截骨术）术后１１～１５年３５８例３７６个膝的远期随诊观察及对膝关节影响的生物力学分析，确认后倾角截骨术导致膝关节载荷传导紊乱是产生该手术远期并发症的原因。为此，对该手术提出如下商榷意见：（１）截骨前应使膝关节屈曲角度减至１０°左右；（２）对于股骨下段向前弧度增大，绳肌肌力又在４级以上的患者，只做伸直截骨，二期行肌替代术；（３）对于连枷膝患者，如若做该手术，则应行连枷膝改造术。

AbstractThe authors had carried out a biomechanical analy-sis on the long term effects to the knee joints followingsupracondylar retroversion osteotomy of the femur(SROF)in 358(376 knees )cases.There were l69males and l89 females with the age ranged between l4～27 and an average of l8.3 years. The deformity in-volved unilateral knee in 284 cases and bilateral in 74cases,In 289 knees, there were quadticeps parlysis be-fore the operation and the muscle power of hamstringsof abeve Ⅲ degree. The follow-up period extended for11 ～ 15 years after surgery. The tesults of long termpostoperative analysls cases revealed that,SROF causeddisorder of loading transmission to the knee joint. Ac-cordingly,the authors made the following suggestions.(1) Before SROF, the angle of flexion of the kneeshould be decreased to approximately l0°;(2 ) only ex-tension osteotomy of the femur should be done for thosecases with increased anterior curvature of the lower endof the femur , and the hamstrings muscle power of overⅣ degree; a secondary muscle replacement operat ion isadvisable for these cases ;(3)For patients with nail kneejoints, SROF should be performed simultaneously withknee reconstruction.