股骨内侧双平面闭合截骨治疗膝外翻

Genu valgum at distal femur treated with medial two-planes supracondylar close osteotomy

目的研究股骨内侧双平面闭合截骨治疗膝外翻的手术技巧和临床疗效。方法回顾性研究自2013年5月至2016年1月在北京积水潭医院行股骨髁上内侧闭合截骨的膝外翻患者25例37膝。纳入标准：（1）膝外翻畸形患者;（2）外翻畸形位于股骨远端,即机械轴上股骨远端外侧角小于87°;（3）胫骨无明确畸形,即机械轴上胫骨近端机械轴内侧角在87°~90°内;（4）膝关节无关节炎表现。排除标准：膝外翻畸形在股骨以外（关节内,或者胫骨）或合并骨性关节炎的患者。随访患者术后骨愈合和并发症的情况,测量手术前后机械轴（股骨头-踝关节中心连线）在膝关节上的交点的位置和胫股角变化。采用SPSS17.0软件,对手术前后的机械轴力线在膝关节经过点及胫股角进行配对t检验。结果入组患者25例37膝,其中男性2例,女性23例;左侧6例,右侧7例,双侧12例;年龄15~53岁,平均（35±11）岁;平均随访时间4~40（19±10）个月。术前机械轴平均落在膝关节（86±15）%处,术后纠正到（43±8）%处,手术后比手术前改善39.7%,组间差异有统计学意义（t=10.45,P〈0.001）。没有矫正不足的案例（机械轴在胫骨平台上交点超过55%为矫正不足）;2例矫正过度（机械轴在胫骨平台上交点小于35%）,到最近随访时没有临床症状。胫股角术前（171.2±3.1）°,术后为（181.2±2.4）°,术后比术前改善10.0°,组间差异有统计学意义（t=8.90,P〈0.001）。全部患者术后获得骨性愈合,没有发生畸形矫正丢失、深静脉栓塞和感染。23例膝（62%）患肢有前内侧软组织刺激不适,在内固定取出后症状消失。结论股骨内侧双平面截骨的手术技术治疗膝外翻畸形操作简便,疗效确切。

Objective To evaluate the outcome of distal femoral genu valgum treated with medial two-planes supracondylar close osteotomy. Methods Distal femoral medial biplane supracondylar osteotomy were performed for the patients with distal femoral valgus deformity from May 2013 to Jan 2016 in Beijing Jishuitan hospital. Inclusion criteria： （ 1 ） patients with genu valgum ; （2） valgus deformity located at distal femur; （3） no deformity at tibia; （4） no osteoarthritis in knee joint. Exclusion criteria： valgus deformity does not exist at distal femur or is associated with arthritis of knee. The patients were followed up for the bony union and complications; radiologically mechanical axis was evaluated. Paired t test was applied to evaluate the data of femoral-tibial angle（FTA） with SPSS. Results Twenty-five patients of 37 knees, with mean age of （35 ± 11 ） years, were enrolled, including two males and 23 females, six left knees, seven right knees and 12 bilateral knees. The mean follow-up time was （ 19± 10） months （range, 4- 40months ）. The intersection of mechanical axis was at （86± 15 ） % of the tibial plateau preoperatively, and was corrected to （ 43 ±8 ） % postoperatively （ t = 10.45, P 〈 0. 001 ）. No undercorrection was recorded, while two overcorrection cases without clinical symptom were observed. FTA was corrected from （ 171.2 ＋ 3.1 ） ° to （ 181.2 ＋ 2.4） ° （t = 8.90, P 〈 0. 001 ）. The bony union was achieved in all the patients without correction loss, deep vein thrombosis, or infection. Twenty-three knees reported discomfort at the anteriomedial thigh, which disappeared after the implants removal. Conclusion Distal femoral medial biplane osteotomy offers convenient and reproducible outcome for distal femoral genu valgum deformity correction.