Lee Dong Hoon, Ryu Keun Jung, Song Sang Heon, Park Kwang Won, Song Hae Ryong
Limb Lengthening and Deformity Reconstruction Service, Department of Orthopaedic Surgery, CHA Bundang Medical Center, 351 Yatap-dong, Bundang-gu, Sung-nam, Kyungki-do, Republic of Korea,
Eur J Orthop Surg Traumatol. 2014 Dec;24(8):1579-85. doi: 10.1007/s00590-013-1338-3. Epub 2013 Oct 25.
During the surgery of lengthening over nail (LON), we sometimes observe sagittal translation of proximal tibia (STPT) when the nail is inserted into the canal. We investigated the factors that lead to STPT and its clinical significance.
We reviewed 35 consecutive patients who underwent bilateral tibial lengthening with LON. The following parameters were assessed to evaluate the factors that can lead to STPT; the level of tibia osteotomy (OT) in sagittal plane, the type of the nail, the nail entry point in sagittal/coronal planes, and the type of the OT. Then, the followings are analyzed to find any possible clinical significance of this phenomenon: the change of posterior proximal tibial angle (PPTA), the cortical healing index, and the translation of the sagittal mechanical axis (SMA) of the lower extremity.
The postoperative STPT was 3.04 ± 2.73 mm, and proximal location of the OT in relation to the nail bending point was found to increase STPT. The nail entry point in sagittal/coronal planes and the type of tibia OT had no significant correlations with STPT. It had no significant relations with the PPTA or cortical healing index. It pushed the SMA posteriorly, but the SMA was always anterior to the center of rotation of the knee joint.
Proximal location of the OT in relation to the nail bending point is related to STPT. However, it does not negatively influence cortical healing, posterior tibial slope, or SMA of the lower extremity.
在经髓内钉延长术（LON）手术过程中，当髓内钉插入髓腔时，我们有时会观察到胫骨近端矢状面移位（STPT）。我们研究了导致STPT的因素及其临床意义。
我们回顾了35例连续接受双侧胫骨LON延长术的患者。评估以下参数以评价可能导致STPT的因素：矢状面胫骨截骨（OT）水平、髓内钉类型、矢状面/冠状面的髓内钉进针点以及OT类型。然后，分析以下各项以找出该现象可能存在的临床意义：胫骨近端后倾角（PPTA）的变化、皮质骨愈合指数以及下肢矢状面机械轴（SMA）的移位。
术后STPT为3.04±2.73mm，发现OT相对于髓内钉弯曲点的近端位置会增加STPT。矢状面/冠状面的髓内钉进针点以及胫骨OT类型与STPT无显著相关性。它与PPTA或皮质骨愈合指数无显著关系。它使SMA向后移位，但SMA始终位于膝关节旋转中心前方。
OT相对于髓内钉弯曲点的近端位置与STPT有关。然而，它对皮质骨愈合、胫骨后倾或下肢SMA没有负面影响。
