Walton David M, Liu Raymond W, Farrow Lutul D, Thompson George H
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 201, Chicago, IL 60612 USA.
J Child Orthop. 2012 Mar;6(1):81-5. doi: 10.1007/s11832-012-0384-4. Epub 2012 Jan 31.
Persistent tibial torsion in the older child can be treated with a derotation osteotomy. Distal tibial osteotomy has been recommended due to concerns of peroneal nerve palsy, vascular injury, and compartment syndrome with a proximal tibial osteotomy. However, an osteotomy in the proximal tibia may achieve union more rapidly and skin issues, as described for distal tibial osteotomies, are less likely. This study investigates the safety and efficacy of proximal tibial derotation osteotomies.
We retrospectively reviewed 43 tibiae in 25 consecutive children with persistent tibial torsion treated with a proximal tibial derotation osteotomy between 1991 and 2006. Patients with concomitant varus or valgus osteotomies were excluded. Diaphyseal fibular osteotomies were performed in five patients, while all patients had a prophylactic anterior compartment fasciotomy.
The mean age at surgery was 10.4 ± 4.0 years and the mean follow-up was 3.2 ± 3.5 years. Patients with internal tibial torsion had a mean preoperative thigh-foot angle (TFA) of -14° ± 6° and a mean postoperative TFA of 8° ± 4°. Patients with external tibial torsion had a mean preoperative TFA of 38° ± 9° and a mean postoperative TFA of 7° ± 5°. The overall mean correction was 26° ± 9°. Major postoperative complications occurred in 4 patients (9%), including one peroneal nerve palsy which resolved, one delayed union requiring revision surgery, and two patients with mild postoperative valgus deformities.
Proximal tibial derotation osteotomy with an anterior compartment fasciotomy is a reliable method for treating tibial torsion with an acceptable complication rate. Given the larger bony surface area and improved soft tissue envelope, proximal tibial derotation osteotomy can be considered as an alternative to a distal tibial derotation osteotomy.
大龄儿童持续性胫骨扭转可通过旋转截骨术治疗。由于担心腓总神经麻痹、血管损伤以及近端胫骨截骨术会引发骨筋膜室综合征，因此有人推荐采用远端胫骨截骨术。然而，近端胫骨截骨术可能会更快实现骨愈合，而且不像远端胫骨截骨术那样容易出现皮肤问题。本研究旨在调查近端胫骨旋转截骨术的安全性和有效性。
我们回顾性分析了1991年至2006年间连续25例接受近端胫骨旋转截骨术治疗持续性胫骨扭转的儿童的43例胫骨。排除同时进行内翻或外翻截骨术的患者。5例患者进行了骨干腓骨截骨术，而所有患者均进行了预防性前侧骨筋膜室切开术。
手术时的平均年龄为10.4±4.0岁，平均随访时间为3.2±3.5年。胫骨内旋患者术前大腿-足部角度（TFA）平均为-14°±6°，术后平均TFA为8°±4°。胫骨外旋患者术前平均TFA为38°±9°，术后平均TFA为7°±5°。总体平均矫正角度为26°±9°。4例患者（9%）出现了严重术后并发症，包括1例已恢复的腓总神经麻痹、1例需要翻修手术的延迟愈合以及2例术后轻度外翻畸形患者。
近端胫骨旋转截骨术联合前侧骨筋膜室切开术是治疗胫骨扭转的可靠方法，并发症发生率可接受。鉴于近端胫骨有更大的骨表面积和更好的软组织包膜，近端胫骨旋转截骨术可被视为远端胫骨旋转截骨术的替代方法。
