股骨髁上V形截骨术治疗膝屈曲畸形(附62例临床观察)

Treatment of knee flexion deformities by V-shape supraeondylar osteotomy

本文总结了股骨髁上V形截骨术治疗62例小儿麻痹后遗膝屈曲的临床资料,有效率96.7％。该术式能将V形尖部嵌入远断端松质骨内,接触面大,位置稳,不需内固定,愈合快;还可同时矫正膝内外翻。在矫正膝屈曲的同时对截骨处做5～18°的后倾角;试验证明:后倾角处可产生向后的分力,以代替股四头肌之拉力。截骨点的选法:髌骨上缘二横指,则相当于股骨髁上4～5cm处;畸形矫正理想,并发症少。采用前内侧斜切口并顺肌间隙分离,可避免肌肉出血和髌上囊损伤,以消除膝部粘连与膝关节僵硬的直接因素,有利于术后膝关节伸屈功能的恢复。故V形截骨法是股髁上截骨术式中较好的一种;以上手术要点是保证疗效的关键。

62 cases with knee flexia deformities following poliomyelitis were corrected by V-shape supracondylar osteotomy. The effective rate was 96.7％. The operative method was that Vshape osteotomy with 5-18 degrees of incline to the back, which produre a component to the back to replace pulling force of the quadriceps muscle of the thigh, was done from 4-5cm above femoral condyle. And the tip of V-shape osteotomy was inserted into the spongy hone in the distal end of osteotomy, which would increase bone healing, stability and the contact area of both osteotomic ends and without internal fixation. The Valgus or Varus deformity of knee was corrected simultaneously. It can be considered that the correcting deformity is better and the complication is less.