分期矫正治疗青少年股骨远端骨骺损伤所致成角和短缩畸形

Staged correction of angular deformity and discrepancy caused by distal femoral physeal injuries in ad- olescent.

目的介绍分期矫正青少年股骨远端骨骺损伤所致成角和短缩畸形的方法，并总结近3年来这方面的治疗结果。方法对2009年6月至2012年10月分期矫正治疗（即先做股骨髁上截骨矫形，矫正股骨远端成角畸形，同时做股骨远端全骺板阻滞，待截骨完全愈合、双下肢不等长逾4em时再做股骨中段截骨延长）的12例患儿进行回顾性分析，评价其疗效。结果12例患儿中，11例获满意随访。11例患儿截骨端均愈合，平均愈合时间3．9个月，膝关节功能完全恢复，无畸形复发。12例患儿中，5例完成一轮成角和短缩治疗周期，4例不需做延长治疗，3例未及做延长治疗。5例二期延长病例中，3例采用外固定支架治疗，其外固定指数（EFI）平均为每厘米1．5个月；2例后期改换钢板内固定。2例发生针道感染。结论分期矫正成角和短缩作为股骨远端骨骺损伤所致畸形的一种治疗方法，能及时矫正股骨下端成角畸形，有利于保护膝关节功能，缺点在于需反复多次手术。对于治疗初期成角畸形明显，而下肢短缩不足4cm的生长期患儿较为适合。

Objetive To propose the staged correction protocol for deformities derived from distal femo- ral physeal injuries in adolescent, and summarize the outcome of the treatment. Method 12 cases of this kind were treated by staged correction of angulation and then discrepancy from Jun. 2009 to Oct. 2012. The clin- ical results were summarized and evaluated according to the Criteria. Results 11 out of 12 cases were fol- lowed-up satisfactorily. All osteotomies healed uneventfully with the mean union time of 3.9 months. Knee functions were fully recovered without recurrence of angular deformity. 5 cases have received one round of cor- rection of angular deformity and then lengthening, 4 cases simple supraeondylar osteotomy of angular deformity, 3 cases awaits for future lengthening. 3 of 5 cases that had secondary lengthening wore external fixator through- out the treatment with the average external fixation index of 1.5 montronm, whereas the other 2 cases changed to internal plate fixation sometime after lengthening. 2 cases were complicated with pin-track infection. Con- elusions Staged correction protocol which is a treatment of adolescent distal femoral deformity have the advan- tage of in-time correction of alignment of the joint while perfectly preserving its function. Its disadvantage is re- peated hospitalizations and operations. It is suitable for those growing children with prominent deformity and less than 4 em shortening on the first presentation in the clinic.