Frey P
Department of Paediatric Traumatology, University Children's Hospital, Basel, Switzerland.
Z Kinderchir. 1990 Oct;45(5):291-7. doi: 10.1055/s-2008-1042603.
Based on our clinical experience, we postulate that the unilateral "posttraumatic genu valgum" develops on the grounds of an unreduced primary valgus deformity. This induces a disturbance of the consolidation on the medial aspect of the fracture. Subsequently, a partial medial stimulation of the epiphyseal plate develops resulting in a secondary valgus deformity. We succeeded in proving experimentally this postulate using the Mini Pig as an experimental model. We investigated 33 tibiae of 17 Mini Pigs. With radiological follow-up studies we were able to show that the operatively created primary valgus deformity induces an increased valgus deformity of functional significance. This is a model of the unreduced fracture in men. However, the transection of the pes anserinus and the periost per se did not provoke a significant valgus formation. Based on these experimental results and our clinical findings we postulate the following treatment for the metaphyseal bending fractures of the proximal tibia in men: 1. Accurate, usually conservative, reduction of any primary valgus malposition of the fracture. 2. Retention of the corrected position of the tibia in a plaster cast. 3. Compression of the medial aspect of the fracture to prevent disturbance of consolidation and subsequent development of valgus deformity.
基于我们的临床经验，我们推测单侧“创伤后膝外翻”是在原发性外翻畸形未得到矫正的基础上发展而来的。这会导致骨折内侧的愈合受到干扰。随后，骨骺板内侧受到部分刺激，从而导致继发性外翻畸形。我们成功地以小型猪作为实验模型，通过实验证明了这一推测。我们对17只小型猪的33根胫骨进行了研究。通过影像学随访研究，我们能够表明手术造成的原发性外翻畸形会导致具有功能意义的外翻畸形增加。这是男性骨折未复位的一种模型。然而，鹅足肌腱和骨膜本身的横断并不会引起明显的外翻形成。基于这些实验结果和我们的临床发现，我们对男性胫骨近端干骺端弯曲骨折提出以下治疗方法：1. 准确复位骨折的任何原发性外翻畸形，通常采用保守方法。2. 用石膏固定保持胫骨的矫正位置。3. 对骨折内侧进行加压，以防止愈合受到干扰以及随后外翻畸形的发展。
