成年人小腿外旋畸形的外科治疗

Surgical Treatment for External Rotation Deformity of Tibia in the Adult

目的 :探讨成年人小腿外旋畸形的成因、手术方法和治疗效果。方法 :回顾性分析 138例 14 4条腿 ,平均年龄 2 9.3岁。小儿麻痹后遗症 116例 ,其它原因 2 2例 ,其中 130例合并髋、膝关节和踝足关节的多种畸形 2 0 9个。术前小腿外旋平均 43° ,手术先截断腓骨 ,在胫骨结节下杵臼形截骨 ,远端内旋至中立位 ,测量棘、髌、踝力线正常 ,合并膝内翻、轻度屈膝和膝反屈畸形者同时矫正 ,截骨端以外固定器或钢针交叉加石膏外固定。结果 :术后随访平均 14个月 ,12 8例小腿外旋畸形完全矫正 ,10例部分矫正。结论 :小腿外旋是渐进发生的常见畸形 ,胫骨结节下内旋截骨是简单有效的手术方法 ,合并髋、膝、踝关节畸形者尽可能同期手术矫正 。

Objective: To explore pathogenesis and surgical treatment of external rotation deformity of the tibia in the adult,and evaluate outcome of the treatment.Methods:A retrospective study was performed in 138 adult patients (144 legs) with an average age of 29.3,including 116 patients secondary to poliomyelitis and 22 patients suffered from other diseases.of them,130 cases were combined with various kinds of hip,knee,ankle and foot malformations to total of 209.Average preoperative external rotation was 43 Surgical procedures were as follows:fibula was cut off firstly,dome osteotomy under tuberosity of tibia was executed,the distal end was turned internally to neutral position to meet normal alignment of the lower limb.Combined medial genu varum,flexed contracture or recurvatum might be corrected simultaneously.External fixator or cross pins incorporated in plaster was used to fix the fragments after correction.Results:The patients were followed up for an average of 14 months.Complete correction of rotation was achieved in 128 patients and partial correction in 10 patients.Conclusion:Derotation osteotomy under tibial tuberosity is simple and effective to correct external rotation of tibia,a common progressing leg deformity.Combined hip,knee,ankle and foot deformities should be corrected at one stage as possible to recover alignment of the leg.