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
目的探讨胫骨结节远端高位截骨术(distal tibial tuberosity high tibial osteotomy,DTT-HTO)中胫骨近端内侧角(medial proximal tibia angle,MPTA)与下肢力线比率(weight-bearing line ratio,WBLR)的相关性,为手术提供依据。方法选取2...目的探讨胫骨结节远端高位截骨术(distal tibial tuberosity high tibial osteotomy,DTT-HTO)中胫骨近端内侧角(medial proximal tibia angle,MPTA)与下肢力线比率(weight-bearing line ratio,WBLR)的相关性,为手术提供依据。方法选取2019年10月至2021年10月在北京中医药大学第三附属医院微创关节科行DTT-HTO治疗的26例(28膝)患者,其中男4例,女22例;左膝9个,右膝19个;年龄50~81岁,平均年龄(65.68±6.53)岁。所有患者均完成手术并随访,期间无不良事件发生。采用MPTA和WBLR评估手术前后下肢力学状态的变化;并计算手术前后MPTA和WBLR的改变值,采用美国特种外科医院(the hospital special surgery,HSS)评分评估手术前后膝关节功能,并计算手术前后HSS的改变值。本研究将WBLR设置在50%~70%的良好位置,采用SPSS 25.0软件进行数据分析。绘制受试者工作特征(receiver-operating characteristic,ROC)曲线,得到曲线下面积(area under the curve,AUC),分别计算50%和70%WBLR对应的MPTA临界值。根据两个临界值将患者分为矫正不足组、矫正适当组和矫正过度组,比较三组患者术前基线信息,术前、术后WBLR、MPTA、HSS和手术前后的改变值。用SPSS 25.0软件绘制术前、术后和手术前后改变值WBLR和MPTA的相关性分析散点图。结果术后WBLR、MPTA、HSS与术前比较均有明显变化,差异有统计学意义(P>0.01)。无论术前、术后或手术前后改变值,MPTA均与WBLR相关,AUC均大于0.5。计算得出,50%和70%WBLR对应的MPTA的临界值分别为90.5°和93.5°,50%和70%WBLR对应的MPTA改变值的临界值分别为6.5°和9.5°。三组术前基线信息差异无统计学意义;术前MPTA、术后MPTA改变值、术后MPTA、术后WBLR、术后HSS和术后WBLR改变值在三组间比较差异有统计学意义,并根据阳性结果进行组间两两比较。结论MPTA对膝骨关节炎有一定的诊断价值。作为一种简单省时的单关节测量方法,建议将MPTA应用于C型臂膝关节术中图像,并作为除下肢力线外HTO测量的参考值,以达到术中测量准确、方便的要求。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.
文摘目的探讨胫骨结节远端高位截骨术(distal tibial tuberosity high tibial osteotomy,DTT-HTO)中胫骨近端内侧角(medial proximal tibia angle,MPTA)与下肢力线比率(weight-bearing line ratio,WBLR)的相关性,为手术提供依据。方法选取2019年10月至2021年10月在北京中医药大学第三附属医院微创关节科行DTT-HTO治疗的26例(28膝)患者,其中男4例,女22例;左膝9个,右膝19个;年龄50~81岁,平均年龄(65.68±6.53)岁。所有患者均完成手术并随访,期间无不良事件发生。采用MPTA和WBLR评估手术前后下肢力学状态的变化;并计算手术前后MPTA和WBLR的改变值,采用美国特种外科医院(the hospital special surgery,HSS)评分评估手术前后膝关节功能,并计算手术前后HSS的改变值。本研究将WBLR设置在50%~70%的良好位置,采用SPSS 25.0软件进行数据分析。绘制受试者工作特征(receiver-operating characteristic,ROC)曲线,得到曲线下面积(area under the curve,AUC),分别计算50%和70%WBLR对应的MPTA临界值。根据两个临界值将患者分为矫正不足组、矫正适当组和矫正过度组,比较三组患者术前基线信息,术前、术后WBLR、MPTA、HSS和手术前后的改变值。用SPSS 25.0软件绘制术前、术后和手术前后改变值WBLR和MPTA的相关性分析散点图。结果术后WBLR、MPTA、HSS与术前比较均有明显变化,差异有统计学意义(P>0.01)。无论术前、术后或手术前后改变值,MPTA均与WBLR相关,AUC均大于0.5。计算得出,50%和70%WBLR对应的MPTA的临界值分别为90.5°和93.5°,50%和70%WBLR对应的MPTA改变值的临界值分别为6.5°和9.5°。三组术前基线信息差异无统计学意义;术前MPTA、术后MPTA改变值、术后MPTA、术后WBLR、术后HSS和术后WBLR改变值在三组间比较差异有统计学意义,并根据阳性结果进行组间两两比较。结论MPTA对膝骨关节炎有一定的诊断价值。作为一种简单省时的单关节测量方法,建议将MPTA应用于C型臂膝关节术中图像,并作为除下肢力线外HTO测量的参考值,以达到术中测量准确、方便的要求。
