Nazem Khalilollah, Fouladi Arash, Chinigarzadeh Mozhdeh
Department of Orthopedics, Isfahan Medical University, Isfahan, Iran.
J Res Med Sci. 2013 Dec;18(12):1092-6.
High tibia osteotomy (HTO) is a common surgical operation for correction of genu varum deformity. In some patients, there are concurrent tibia vara and genu varum (bow leg). This study aimed to consider the possibility of better correction of bow leg deformity after double level tibial osteotomy (DLTO).
A case series of 10 patients of genu varum in addition to tibia vara (bow leg) deformity who were referred to orthopedic ward of an academic hospital of Isfahan- Iran during 2009-2011 were included in the study. The mean age was 17.3 ± 3.1 years and all of them underwent DLTO. The results of treatment have been assessed based on clinical and radiological parameters before and after surgery.
The mean pre- and post operative values for Tibia-Femoral Angle, Medial Proximal of Tibia Angle (MPTA), and Lateral Distal of Tibia Angle (LDTA) were 18.13 ± 3.05° vs. 3.93 ± 0.66°, 79.13 ± 3.4° vs. 89.7 ± 1.8° and 96.40 ± 1.8° vs. 88.73 ± 3.0° respectively (P < 0.05). Improvement of all radiological parameters was meaningful. Seventy three percent of patients had normal mechanical axis of limb after surgery. The remaining cases had varus deformity in distal femur that was corrected by valgus supracondylar osteotomy in an additional operation. Limited range of motion (ROM) near knee and ankle was not observed.
DLTO correct bow leg deformity in the point of alignment of limb and paralleling of knee and ankle joint more effectively. This method can be used in metabolic and congenital bow leg which deformities are present in throughout of the lower limb. We described this technique for the first time.
高位胫骨截骨术（HTO）是矫正膝内翻畸形的常见外科手术。在一些患者中，同时存在胫骨内翻和膝内翻（弓形腿）。本研究旨在探讨双平面胫骨截骨术（DLTO）后更好地矫正弓形腿畸形的可能性。
本研究纳入了2009年至2011年期间转诊至伊朗伊斯法罕一家学术医院骨科病房的10例除胫骨内翻（弓形腿）畸形外还伴有膝内翻的患者。平均年龄为17.3±3.1岁，所有患者均接受了DLTO手术。根据手术前后的临床和放射学参数评估治疗结果。
胫股角、胫骨近端内侧角（MPTA）和胫骨远端外侧角（LDTA）的术前和术后平均数值分别为18.13±3.05°对3.93±0.66°、79.13±3.4°对89.7±1.8°以及96.40±1.8°对88.73±3.0°（P<0.05）。所有放射学参数的改善均具有显著意义。73% 的患者术后肢体机械轴正常。其余病例股骨远端存在内翻畸形，在另外的手术中通过髁上外翻截骨术进行了矫正。未观察到膝关节和踝关节附近的活动范围（ROM）受限。
DLTO能更有效地在肢体对线以及膝关节和踝关节平行方面矫正弓形腿畸形。该方法可用于整个下肢存在畸形的代谢性和先天性弓形腿。我们首次描述了这种技术。
