Stähelin T, Hardegger F
Kantonales Spital Sursee-Wolhusen, Schweiz.
Orthopade. 2004 Feb;33(2):178-84. doi: 10.1007/s00132-003-0589-9.
The aim of treatment of a valgus deformity and osteoarthrosis of the lateral compartment of the knee is to obtain axial correction of the misalignment of the extremity. Osteosynthesis of the osteotomized femur using internal fixation and a stiff implant has not been as successful as expected. We evaluated the accuracy of correction and the stability of fixation with a malleable plate after 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 closing-wedge osteotomy of the distal aspect of the femur in 32 consecutive patients (34 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 52 years, and the mean follow-up period was 4.4 years. In 32 knees, the osteosynthesis withstood the mechanical loading that occurred during the functional rehabilitation program. Due to pain or incorrect weight bearing, splinting was necessary to maintain the integrity of the osteosynthesis in three knees. The osteosynthesis failed in two knees. The mean deviation of the achieved tibiofemoral axis in the healed bone from the intended tibiofemoral axis was less than 2 degrees, and the maximal deviation less than 5 degrees. The Insall score was 21 points higher 4.4 years postoperatively than it had been preoperatively. Our method allows reliable correction of the tibiofemoral axis using intrinsic stability mechanisms to compress the congruently aligned cut ends of the cortical tubes. We believe that our technique provides an alternative to osteosynthesis using of a stiff implant such as a fixed-angle blade-plate device.
治疗膝外翻畸形及外侧间室骨关节炎的目的是实现肢体对线不良的轴向矫正。使用内固定和坚固植入物对截骨后的股骨进行接骨术，其效果并未达到预期。我们评估了为矫正膝关节外翻畸形而在股骨远端髁上截骨后，使用可塑形钢板进行矫正的准确性和固定的稳定性。我们对32例连续患者（34个膝关节）进行了股骨远端不完全斜行闭合楔形截骨术，并用可塑形半管状钢板稳定截骨部位，该钢板弯曲成角状钢板，并使用拉力螺钉。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52岁，平均随访期为4.4年。在34个膝关节中，接骨术在功能康复计划期间承受了机械负荷。由于疼痛或负重不当，有3个膝关节需要使用夹板来维持接骨术的完整性。有2个膝关节的接骨术失败。愈合骨中实际胫股轴线与预期胫股轴线的平均偏差小于2度，最大偏差小于5度。术后4.4年，Insall评分比术前高21分。我们的方法利用内在稳定机制压缩皮质骨管的对合截骨端，从而可靠地矫正胫股轴线。我们认为，我们的技术为使用如固定角度刀片钢板装置等坚固植入物进行接骨术提供了一种替代方法。
