胫骨结节下截骨结合泰勒空间外固定器治疗成人特发性膝内翻

Application of tibiofibular osteotomy combine with Taylor spatial frame for the correction of adult idiopathic genu varum

目的:研究胫骨结节下截骨结合泰勒空间外固定器(TSF)治疗成人特发性膝内翻的早期临床效果。方法:回顾性分析2018年1月至2022年1月采用胫骨结节下截骨结合TSF治疗12例成人膝内翻患者的临床资料,均为双侧膝内翻,男4例,女8例;年龄18~35岁,平均(27.7±5.3)岁。于小腿中下段截断腓骨,然后安装小腿TSF,最后做胫骨结节下截骨;术后7 d开始依据TSF电子处方调整并矫正膝内翻畸形。记录患者术前和末次随访时美国膝关节协会评分(KSS)临床评分及功能评分、机械轴偏移(MAD)、胫骨近端内侧角(MPTA),评价临床治疗效果。结果:所有患者均顺利完成手术,无一例发生血管神经损伤,TSF在术后21 d内调整完毕,下肢力线达到满意矫正,继续佩带TSF维持矫正,佩带时间为118~166 d,平均(133.6±13.5)d。随访时间19~49个月,平均(35.7±8.5)个月,末次随访KSS临床评分及功能评分较术前改善(P<0.01),末次随访MAD较术前减小(P<0.01),末次随访MPTA较术前增大(P<0.01),畸形均获得矫正。结论:胫骨结节下截骨结合TSF治疗成人特发性膝内翻,微创、安全、精确、可靠,短期随访效果满意。

Objective:To study the short-term clinical effect of high tibial osteotomy combined with Taylor spatial frame(TSF)on adult idiopathic genu varus.Methods:A retrospective analysis was conducted on the clinical data of 12 adult patients with bilateral genu varum treated by high tibial osteotomy combined with TSF from January 2018 to January 2022.There are 4 males and 8 females with a mean age of(27.7±5.3)years(range,18-35 years).TSF was installed after the fibula was cut off in the middle and lower segments of the lower leg,and then tibial tubercle osteotomy was performed.The genu varum was corrected by adjusting the external fixator according to TSF electronic prescribing since 7th day after operation.The clinical and functional Knee Society Score(KSS),mechanical axis deviation(MAD),and medial proximal tibial angle(MPTA)were recorded before surgery and at the last follow-up.Results:The surgery was successfully completed in all the patients,and no vascular or nerve injury occurred.TSF was adjusted within 21 d after surgery and continued to be worn for correction.The mean wearing time was(133.6±13.5)d(range,118-166 d).The mean duration of follow-up was(35.7±8.5)months(range,19-49 months).Compared with preoperative ones,clinical and functional KSS scores and MPTA were significantly increased,and MAD significantly decreased at the last follow-up(P<0.01).Conclusions:Tibiofibular osteotomy combined with TSF is minimally invasive,safe,accurate and reliable for adult idiopathic Genu varum.Its short-term follow-up effect is satisfactory.