Hefny Hany, Shalaby Hisham, El-Kawy Sameh, Thakeb Moutaz, Elmoatasem Elhussein
Ain Shams University, Limb Reconstruction Unit, Cairo, Egypt.
J Pediatr Orthop. 2006 Mar-Apr;26(2):233-7. doi: 10.1097/01.bpo.0000218530.59233.ab.
Neglected infantile Tibia Vara is a very challenging clinical problem with many technical problems including distorted joint line secondary to the medial tibial plateau depression, obesity leading to difficulty in exposure, performing osteotomies and difficulty in osteotomy fixation. The aim of this study is to evaluate the clinical and radiological results of treatment of severe neglected infantile Tibia Vara using a new osteotomy to elevate the depressed medial tibial plateau in conjunction with the Ilizarov technique. Seven tibias in five patients were included in this study. These were all Stage V and VI according to Langenskiold and Riska classification. The average age at surgery was 11.6 years (ranging from 8 to 15), and the average follow-up was 6.2 years (ranging from 3 to 10). A new double osteotomy technique was used to elevate the depressed medial tibial plateau and correct the varus deformity. Correction was done gradually using the Ilizarov Frame. The results were assessed clinically and radiologically. The femoral shaft -- tibial shaft angle improved from an average of 36 degrees of varus preoperatively to 4 degrees of varus. The femoral condyle-tibial shaft angle improved from an average of 58 degrees to 83 degrees. The angle of depressed medial tibial plateau improved from an average of 53 degrees to 10 degrees. We believe that our new double elevating osteotomy in conjunction with Ilizarov technique is an excellent modality for patients with stage V and VI according to the Langenskiold and Riska classification. The advantages of this technique include correction of the deformity with simultaneous correction of the joint architecture, immediate weight bearing, and avoidance of excessive dissection needed for internal fixation.
neglected infantile Tibia Vara是一个极具挑战性的临床问题，存在诸多技术难题，包括继发于胫骨内侧平台凹陷导致的关节线扭曲、肥胖致使暴露困难、进行截骨术以及截骨固定困难等。本研究的目的是评估采用一种新的截骨术抬高凹陷的胫骨内侧平台并结合Ilizarov技术治疗重度 neglected infantile Tibia Vara的临床和影像学结果。本研究纳入了5例患者的7条胫骨。根据Langenskiold和Riska分类，这些均为V期和VI期。手术时的平均年龄为11.6岁（范围8至15岁），平均随访时间为6.2年（范围3至10年）。采用一种新的双截骨技术抬高凹陷的胫骨内侧平台并纠正内翻畸形。使用Ilizarov框架逐步进行矫正。从临床和影像学方面评估结果。股骨干-胫骨干角度从术前平均内翻36度改善至内翻4度。股骨髁-胫骨干角度从平均58度改善至83度。胫骨内侧平台凹陷角度从平均53度改善至10度。我们认为，根据Langenskiold和Riska分类，我们新的双抬高截骨术结合Ilizarov技术对于V期和VI期患者是一种极佳的治疗方式。该技术的优点包括矫正畸形的同时矫正关节结构、可立即负重以及避免内固定所需的过度解剖。
