Elzohairy Mohamed Mansour, Khairy Hosam Mohamed
Faculty of Medicine, Zagazig University Hospitals, Sharkia, Egypt.
Clin Orthop Surg. 2016 Sep;8(3):310-5. doi: 10.4055/cios.2016.8.3.310. Epub 2016 Aug 10.
Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature.
Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up.
The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p < 0.001). Radiological results showed that all osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p < 0.001) at the final follow-up. The femoral neck shaft angle was improved from 93.7° to 129.9° (p < 0.001) at the final follow-up. Shortening of the affected limb was corrected from 2.8 cm to 1.3 cm (p < 0.001) at the last follow-up. No major serious complications were recorded in the present study.
Intertrochanteric valgus osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara. With careful planning, it can result in a low complication rate and insignificant or minimal recurrence rate.
尽管转子下外翻截骨术被视为治疗髋内翻的标准手术方法，但在最佳固定方法和截骨技术上尚无共识。截骨的固定已通过多种方法实现，包括外固定以及使用钢针、环扎带和各种钢板的内固定。本研究的目的是评估采用T形支撑钢板固定的Y形转子间外翻截骨术治疗发育性髋内翻的结果，并与文献中其他固定方法进行比较。
对18例患者（18髋）进行了18次转子间股骨矫正外翻截骨术，以治疗单侧发育性髋内翻畸形，并用T形钢板固定。其中男性12例，女性6例。10例患者右侧髋关节受累，8例患者左侧髋关节受累。临床上，通过拉森髋关节评分对患者进行评估。影像学上，术前拍摄骨盆前后位片和患侧髋关节蛙式侧位片，并与最终随访结果进行比较。
平均随访29个月（范围为24至36个月）。临床结果显示，拉森髋关节平均评分从57.8提高到97.0（p<0.001）。影像学结果显示，所有截骨在2.4个月（范围为2至3个月）完全愈合，达到了计划的矫正角度。在最终随访时，希尔根赖纳骨骺角的平均矫正从78.2°提高到27.8°（p<0.001）。股骨颈干角在最终随访时从93.7°提高到129.9°（p<0.001）。患侧肢体短缩在最后一次随访时从2.8 cm矫正至1.3 cm（p<0.001）。本研究中未记录到重大严重并发症。
采用T形钢板固定的股骨近端转子间外翻截骨术治疗发育性髋内翻可能有效。通过精心规划，可导致低并发症发生率和微不足道或极小的复发率。
