Naqvi Gohar, Stohr Kuldeep, Rehm Andreas
Department of Orthopaedics Surgery, Addenbrookes Hospital, Hills Rd, Cambridge CB2 0QQ, UK.
SICOT J. 2017;3:49. doi: 10.1051/sicotj/2017033. Epub 2017 Jul 4.
The purpose of this study is to assess the symptoms caused by excessive femoral anteversion and the outcomes of femoral derotation osteotomy.
We reviewed data on patients who underwent proximal femoral derotation osteotomy for symptomatic intoeing gait caused by femoral anteversion. Only symptomatic patients were considered for corrective derotation osteotomy. Degree of femoral anteversion was confirmed on computed tomography (CT) scan.
Thirty-five extremities were operated in 21 patients with an average age of 13.3 (8-18) years. Mean follow-up was 16 months (6-36 months). Mean femoral anteversion angle was 40.8° (28°-53°). External rotation of extended hips improved significantly, from 30° to 51.8° (p < 0.0001). Mean foot progressing angle improved from 15.2° internally rotated preoperatively to 7.7° externally rotated. Intoeing completely resolved in all except two patients. Thirteen out of 21 children complained about tripping and frequent falling while running and playing sports, eight patients had hip pain while 13 children had knee pain preoperatively. Tripping, falling and hip pain resolved in all patients postoperatively, while three patients whose primary complaint was knee pain failed to improve postsurgery. Eighteen of the 21 parents were satisfied with the decision to perform surgical correction.
Excessive femoral anteversion can present with unexplained hip or knee pain refractory to conservative treatments. Careful assessment of lower limb malalignment is a valuable tool in such circumstances and derotation proximal femoral osteotomy can certainly be a procedure of choice in carefully selected cases.
本研究旨在评估股骨前倾过大所引起的症状以及股骨旋转截骨术的治疗效果。
我们回顾了因股骨前倾导致症状性内八字步态而接受股骨近端旋转截骨术患者的数据。仅对有症状的患者进行矫正性旋转截骨术。通过计算机断层扫描（CT）确定股骨前倾的程度。
21例患者共35个肢体接受了手术，平均年龄1十三点三岁（8 - 18岁）。平均随访时间为16个月（6 - 36个月）。平均股骨前倾角度为40.8°（28° - 53°）。伸直髋关节时的外旋角度显著改善，从30°增至51.8°（p < 0.0001）。平均足部前进角度从术前内旋15.2°改善为外旋7.7°。除两名患者外，内八字均完全消失。21名儿童中有13名抱怨在跑步和进行体育活动时绊倒及频繁跌倒，8名患者术前有髋关节疼痛，13名儿童术前有膝关节疼痛。术后所有患者的绊倒、跌倒及髋关节疼痛均消失，但3名以膝关节疼痛为主诉的患者术后未改善。21名家长中有18名对进行手术矫正的决定感到满意。
股骨前倾过大可能表现为经保守治疗难以缓解的不明原因髋关节或膝关节疼痛。在这种情况下，仔细评估下肢畸形是一项有价值的手段，对于精心挑选的病例，股骨近端旋转截骨术无疑可作为一种选择的手术方式。
