Orthopaedics, Traumatology and Surgical Reconstructive Department, La Cavale Blanche Hospital, Brest University Hospital Center, boulevard Tanguy-Prigent, 29200 Brest, France.
Orthop Traumatol Surg Res. 2009 Oct;95(6):414-9. doi: 10.1016/j.otsr.2009.05.006. Epub 2009 Aug 14.
The goal of this retrospective study is to analyze a series of ten patients (11 osteotomies) who underwent closed femoral rotational osteotomy using an endomedullary saw; stabilization was achieved by a locked centromedullary nail. We report the indications, technical aspects, clinical and radiological results as well as intercurrent complications with this surgical technique.
Femoral endomedullary osteotomy is a safe procedure to correct malrotations.
Eleven femoral rotational osteotomies using an endomedullary saw were performed on ten patients, between January 1999 and July 2007. The indications were post-traumatic rotational malunions or congenital rotational deformities. The angular deformity averaged 33.5 degrees (24 degrees -52 degrees ). They were divided into internal rotation (ten cases) or external rotation (one case). One patient required a bilateral rotational osteotomy because of a congenital femoral malrotation combined to bilateral trochlear dysplasia. Rotational correction was, in two patients, simultaneously associated with a closed lengthening osteotomy. Clinical and radiological follow-up averaged 4 years and 9 months (26-104 months). The angular corrections obtained by these rotation osteotomies were calculated by CAT scans.
Ten out of eleven osteotomies allowed a correction within a 4 degrees range in relation to the physiological femoral neck anteversion values (or to the contralateral side in the case of a healthy opposite lower extremity). There was no bone, joint, skin, or soft tissues infection, no pseudoarthrosis and no delayed outgrowth. We observed a transient neurological complication in the area of the pudendal nerve, during a combined rotational-lengthening osteotomy, as well as a bilateral femoral fracture during the bilateral rotational osteotomy. In all patients, consolidation occurred within a 3- to 5-month delay. The subjective results showed that eight out of nine patients (one was lost to follow-up) were satisfied or very satisfied with their operation, their functional recovery and the aesthetic aspects of their scars.
Closed rotational osteotomies in adults represent a reliable, effective, safe and reproducible procedure for the correction of femoral torsion problems, whether they are post-traumatic or congenital. These results can be obtained only by respecting the indications and by applying a rigorously planned technique, including expertise in centromedullary nailing.
Level IV, retrospective therapeutic study.
本回顾性研究的目的是分析 10 例（11 处截骨）采用髓内锯行闭合股骨旋转截骨术的患者，所有患者均采用带锁髓内钉固定。我们报告了这种手术技术的适应证、技术要点、临床和影像学结果以及并发的并发症。
股骨髓内旋转截骨术是纠正旋转畸形的一种安全方法。
1999 年 1 月至 2007 年 7 月，10 例患者（11 处截骨）接受了髓内锯行闭合股骨旋转截骨术。适应证为创伤后旋转畸形愈合或先天性旋转畸形。平均角畸形为 33.5°（24°-52°）。它们分为内旋（10 例）或外旋（1 例）。1 例因先天性股骨旋转不良合并双侧滑车发育不良，需行双侧旋转截骨术。在 2 例患者中，同时行闭合延长截骨术矫正旋转畸形。平均临床和影像学随访时间为 4 年 9 个月（26-104 个月）。通过 CAT 扫描计算这些旋转截骨术后获得的角度矫正值。
11 处截骨中有 10 处可在 4°范围内矫正，与生理性股骨颈前倾角值一致（或在健康对侧下肢的情况下与对侧一致）。无骨、关节、皮肤或软组织感染、假关节形成和延迟愈合。我们在一次联合旋转延长截骨术中观察到会阴部神经的短暂神经并发症，以及在双侧旋转截骨术中发生双侧股骨干骨折。所有患者均在 3-5 个月的延迟期内实现骨愈合。主观结果显示，9 例患者中的 8 例（1 例失访）对手术、功能恢复和疤痕的美观效果感到满意或非常满意。
成人闭合性旋转截骨术是一种可靠、有效、安全和可重复的方法，可矫正股骨扭转问题，无论是创伤后还是先天性的。只有通过遵守适应证，并采用严格计划的技术，包括髓内钉技术，才能获得这些结果。
IV 级，回顾性治疗研究。
