Li Ying, Spencer Samantha A, Hedequist Daniel
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
J Pediatr Orthop. 2013 Apr-May;33(3):276-81. doi: 10.1097/BPO.0b013e31828800fe.
Four percent of children and adolescents in the United States are morbidly obese. Treatment for tibia vara includes proximal tibial osteotomy and correction with a Taylor Spatial Frame (TSF). There are no reports that specifically examine the success of this technique in morbidly obese adolescents.
A retrospective review was conducted of patients between 12 and 18 years of age with a body mass index for age at or above the 99th percentile who had undergone gradual correction of tibia vara with proximal tibial osteotomy and application of a TSF at our institution between 2005 and 2009. Deformity analysis was performed on full-length standing anteroposterior radiographs of both lower extremities and lateral radiographs of the involved tibia obtained preoperatively and at latest follow-up. All complications were recorded.
Fourteen patients met the inclusion criteria. The mean age was 13 years. The average body mass index was 45 kg/m. Preoperative deformity analysis demonstrated a mean mechanical axis deviation of 90 mm, mean mechanical medial proximal tibial angle of 66 degrees, and mean posterior proximal tibial angle of 80 degrees. Analysis at an average follow-up of 14 months demonstrated a mean mechanical axis deviation of 10 mm, mean mechanical medial proximal tibial angle of 88 degrees, and mean posterior proximal tibial angle of 81 degrees. Complications specifically related to the TSF occurred in 2 patients. Both experienced strut disengagement and loss of osteotomy position. This was treated with refastening of the strut and a new program of deformity correction. Complications related to the deformity correction occurred in 3 patients. One had premature fibular consolidation requiring repeat osteotomy, 1 developed a transient partial deep peroneal nerve palsy, and 1 experienced thigh soft tissue irritation from the proximal ring necessitating early TSF removal. One patient had a residual leg-length discrepancy that required tibial lengthening.
Correction of tibia vara with proximal tibial osteotomy and application of a TSF is an effective treatment option in morbidly obese adolescents. Associated complications are minimal.
Level IV-therapeutic study.
美国4%的儿童和青少年患有重度肥胖症。胫骨内翻的治疗方法包括胫骨近端截骨术以及使用泰勒空间框架（TSF）进行矫正。目前尚无专门研究该技术在重度肥胖青少年中成功率的报告。
对2005年至2009年间在我们机构接受胫骨近端截骨术并应用TSF进行胫骨内翻逐渐矫正的12至18岁、体重指数（BMI）处于或高于同年龄第99百分位数的患者进行回顾性研究。对术前及最后一次随访时获得的双下肢全长站立位前后位X线片以及受累胫骨的侧位X线片进行畸形分析。记录所有并发症。
14例患者符合纳入标准。平均年龄为13岁。平均体重指数为45kg/m²。术前畸形分析显示平均机械轴偏差为90mm，平均胫骨近端内侧机械角为66度，平均胫骨近端后侧角为80度。平均随访14个月时的分析显示平均机械轴偏差为10mm，平均胫骨近端内侧机械角为88度，平均胫骨近端后侧角为81度。2例患者出现了与TSF具体相关的并发症。两人均出现支柱脱离和截骨位置丢失。通过重新固定支柱和新的畸形矫正方案进行了治疗。3例患者出现了与畸形矫正相关的并发症。1例因腓骨过早愈合需要再次截骨，1例出现短暂性部分腓深神经麻痹，1例因近端环引起大腿软组织刺激而需要提前拆除TSF。1例患者存在残留的下肢长度差异，需要进行胫骨延长。
胫骨近端截骨术联合TSF矫正胫骨内翻是重度肥胖青少年的一种有效治疗选择。相关并发症极少。
IV级治疗性研究。
