Stähelin T, Hardegger F, Ward J C
Regionalspital Surselva, Ilanz, Switzerland.
J Bone Joint Surg Am. 2000 May;82(5):712-22. doi: 10.2106/00004623-200005000-00012.
The goal of treatment of a valgus deformity of the knee that is secondary to osteoarthritis of the lateral compartment is to obtain axial correction of the malalignment of the extremity. Osteosynthesis of the osteotomized femur with use of internal fixation and a stiff implant has not been as successful as expected. We evaluated the accuracy and maintenance of correction and the stability of fixation with a malleable plate after a supracondylar osteotomy of the distal aspect of the femur that was performed to correct a valgus deformity of the knee.
We performed an incomplete oblique osteotomy of the distal aspect of the femur in nineteen patients (twenty-one knees) and stabilized the osteotomy site with a malleable semitubular plate, which was bent to form an angled plate, and lag-screws. Postoperatively, the patients were immediately encouraged to walk, with partial weight-bearing on the affected extremity. The mean age of the patients was fifty-seven years (range, thirty-nine to seventy-one years), and the mean duration of follow-up was five years (range, two to twelve years).
In seventeen knees, the osteosynthesis withstood the mechanical loading that occurred during the postoperative functional rehabilitation program. Prolonged use of crutches or immobilization, or both, was necessary after the operation in three knees. The osteosynthesis failed in one knee. The loss of correction in eighteen knees, after bone-healing, averaged 1.7 degrees (range, 0 to 4 degrees).
Our method of achieving osteosynthesis is based on the concept that inherent endogenous stability mechanisms can be mobilized by circumferentially compressing the two cortical tubes with the cut ends congruently apposed to each other. We believe that our technique provides an alternative to osteosynthesis with use of a stiff implant such as a fixed-angle blade-plate device.
外侧间室骨关节炎继发的膝外翻畸形的治疗目标是实现肢体对线不良的轴向矫正。使用内固定和刚性植入物对截骨后的股骨进行接骨术，效果并不如预期。我们评估了股骨远端髁上截骨术（用于矫正膝外翻畸形）后，使用可塑形钢板进行接骨时矫正的准确性、矫正的维持情况以及固定的稳定性。
我们对19例患者（21个膝关节）的股骨远端进行了不完全斜行截骨术，并用可塑形半管状钢板（弯曲成角状钢板）和拉力螺钉固定截骨部位。术后，鼓励患者立即行走，患侧肢体部分负重。患者的平均年龄为57岁（范围39至71岁），平均随访时间为5年（范围2至12年）。
在17个膝关节中，接骨术能够承受术后功能康复计划期间产生的机械负荷。术后，3个膝关节需要长期使用拐杖或进行固定，或两者同时使用。1个膝关节的接骨术失败。18个膝关节在骨愈合后的矫正丢失平均为1.7度（范围0至4度）。
我们实现接骨术的方法基于这样一种理念，即通过周向压缩两个皮质骨管，使断端相互贴合，可以调动内在的内源性稳定机制。我们认为，我们的技术为使用刚性植入物（如固定角度的刀片钢板装置）进行接骨术提供了一种替代方法。
