Feldman David S, Goldstein Rachel Y, Kurland Adam M, Sheikh Taha Abdel Majid
Division of Pediatric Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
Division of Pediatric Orthopaedics, Children's Hospital Los Angeles, Los Angeles, California.
J Bone Joint Surg Am. 2016 Jan 20;98(2):100-7. doi: 10.2106/JBJS.O.00308.
A deficiency of the lateral compartment of the knee, often in the setting of skeletal dysplasia, is an intra-articular deformity resulting in genu valgum. Historically, this abnormality has been treated using an extra-articular approach. Lateral hypoplasia of the femoral condyle can be treated with advancement of the lateral femoral condyle without creating a secondary deformity. The purpose of this study was to present the technique and results of lateral condylar advancement, with or without tibial hemiplateau elevation, in patients with intra-articular valgus deformity secondary to skeletal dysplasia.
A retrospective review of the cases of five patients, from seven to twenty-one years old, with skeletal dysplasia and unilateral or bilateral severe genu valgum deformity was performed. For all patients, the etiology of the deformity was a deficient lateral compartment of the knee-that is, lateral femoral condylar hypoplasia with or without concomitant lateral hemiplateau depression. Lateral femoral condylar advancement with or without lateral tibial hemiplateau elevation was performed in eight knees.
The average tibiofemoral angle was 34.7° of valgus preoperatively and improved to 9.4° of valgus at the most recent follow-up. The average length of follow-up was 2.9 years (range, 1.0 to 5.2 years). The average range of motion at the time of final follow-up was an arc of 108° starting from full extension. All osteotomies healed uneventfully. All five patients were satisfied with both the cosmetic appearance and the function of the involved limb and were able to walk without assistive devices.
In patients with a deficient lateral compartment of the knee, lateral femoral condylar advancement with or without hemiplateau elevation allowed correction of severe genu valgum without the creation of an oblique joint line. This technique allows correction of the overall mechanical axis, restoring both function and the cosmetic appearance of the limb.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
膝关节外侧间室缺损，常发生于骨骼发育异常的情况下，是一种导致膝外翻的关节内畸形。从历史上看，这种异常一直采用关节外入路进行治疗。股骨髁外侧发育不全可通过股骨髁前移进行治疗，而不会造成继发性畸形。本研究的目的是介绍在骨骼发育异常继发关节内外翻畸形的患者中，行或不行胫骨半平台抬高的外侧髁前移技术及结果。
对5例年龄在7至21岁、患有骨骼发育异常且有单侧或双侧严重膝外翻畸形的患者病例进行回顾性研究。对于所有患者，畸形的病因是膝关节外侧间室缺损，即股骨髁外侧发育不全，伴或不伴有外侧半平台凹陷。对8个膝关节进行了股骨髁外侧前移，行或不行胫骨外侧半平台抬高。
术前平均胫股角为外翻34.7°，最近一次随访时改善至外翻9.4°。平均随访时间为2.9年（范围1.0至5.2年）。末次随访时平均活动范围是从完全伸直开始的108°弧度。所有截骨均顺利愈合。所有5例患者对患侧肢体的外观和功能均满意，且能够无需辅助装置行走。
对于膝关节外侧间室缺损的患者，行或不行半平台抬高的股骨髁外侧前移可矫正严重膝外翻，且不会形成斜形关节线。该技术可矫正整体机械轴，恢复肢体的功能和外观。
治疗性IV级。有关证据水平的完整描述，请参见作者须知。
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