Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resecti...Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone(genu varum) will result in persistence of the internal tibial torsion(the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blount's disease. Both coronal and axial deformities were corrected in this patient. We propose this combination(rather than the lateral growth modulation alone) as the method of treatment for early stages of Blount's disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy.展开更多
目的:对于伴有严重髌骨轨迹不良的复发性髌骨脱位患者,比较股骨远端旋转截骨与三联术式在临床疗效上的差异。方法:从2010年1月至2017年12月连续就诊的复发性髌骨脱位患者中筛选出术前存在严重髌骨轨迹不良的复发性髌骨脱位患者共50例,其...目的:对于伴有严重髌骨轨迹不良的复发性髌骨脱位患者,比较股骨远端旋转截骨与三联术式在临床疗效上的差异。方法:从2010年1月至2017年12月连续就诊的复发性髌骨脱位患者中筛选出术前存在严重髌骨轨迹不良的复发性髌骨脱位患者共50例,其中22例行股骨远端旋转截骨+内侧髌股韧带重建术(旋转截骨组),其余28例行传统三联术式(髌骨外侧支持带松解、内侧髌股韧带重建和胫骨结节移位)(对照组)。术前测量髌骨高度、滑车发育Dejour分型、胫骨结节-股骨滑车距离、股骨前倾角、胫骨外旋角等影像学参数。最终随访时评估临床功能评分(Kujala,Lysholm和Tegner评分)、髌骨松弛指数以及髌骨再脱位率,并比较上述指标在旋转截骨组和对照组间的差异。结果:本研究共纳入50例患者,平均随访时间为4.9年,亚组分析结果显示,旋转截骨组的Kujala评分(82.1 vs 76.2,P=0.016)和Tegner评分(5.2 vs 4.1,P=0.001)均显著高于对照组。髌骨应力像结果显示旋转截骨组的髌骨松弛指数显著低于对照组(29%vs 43%,P=0.011)。在随访期间,旋转截骨组患者无髌骨再脱位发生,但对照组有7名患者出现髌骨再脱位,其再脱位率显著高于旋转截骨组(25%vs 0,P=0.014)。结论:对于术前存在严重髌骨轨迹不良的复发性髌骨脱位患者,股骨远端旋转截骨的临床疗效显著优于三联术式,术后患者具有更高的临床功能评分,更好的术后髌骨稳定性及更低的髌骨再脱位率。展开更多
文摘Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone(genu varum) will result in persistence of the internal tibial torsion(the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blount's disease. Both coronal and axial deformities were corrected in this patient. We propose this combination(rather than the lateral growth modulation alone) as the method of treatment for early stages of Blount's disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy.
文摘目的:对于伴有严重髌骨轨迹不良的复发性髌骨脱位患者,比较股骨远端旋转截骨与三联术式在临床疗效上的差异。方法:从2010年1月至2017年12月连续就诊的复发性髌骨脱位患者中筛选出术前存在严重髌骨轨迹不良的复发性髌骨脱位患者共50例,其中22例行股骨远端旋转截骨+内侧髌股韧带重建术(旋转截骨组),其余28例行传统三联术式(髌骨外侧支持带松解、内侧髌股韧带重建和胫骨结节移位)(对照组)。术前测量髌骨高度、滑车发育Dejour分型、胫骨结节-股骨滑车距离、股骨前倾角、胫骨外旋角等影像学参数。最终随访时评估临床功能评分(Kujala,Lysholm和Tegner评分)、髌骨松弛指数以及髌骨再脱位率,并比较上述指标在旋转截骨组和对照组间的差异。结果:本研究共纳入50例患者,平均随访时间为4.9年,亚组分析结果显示,旋转截骨组的Kujala评分(82.1 vs 76.2,P=0.016)和Tegner评分(5.2 vs 4.1,P=0.001)均显著高于对照组。髌骨应力像结果显示旋转截骨组的髌骨松弛指数显著低于对照组(29%vs 43%,P=0.011)。在随访期间,旋转截骨组患者无髌骨再脱位发生,但对照组有7名患者出现髌骨再脱位,其再脱位率显著高于旋转截骨组(25%vs 0,P=0.014)。结论:对于术前存在严重髌骨轨迹不良的复发性髌骨脱位患者,股骨远端旋转截骨的临床疗效显著优于三联术式,术后患者具有更高的临床功能评分,更好的术后髌骨稳定性及更低的髌骨再脱位率。
