Fragomen Austin T, Fragomen Fiona R
Weill Medical College, Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Strategies Trauma Limb Reconstr. 2017 Nov;12(3):159-167. doi: 10.1007/s11751-017-0298-2. Epub 2017 Oct 16.
Salter Harris fractures of the distal femur can lead to growth disturbance with resulting leg length inequality and knee deformity. We have looked at a case series (3) of patients who presented with a distal femur flexion malunion and shortening treated with a distal femoral osteotomy and plating and a proximal femoral osteotomy with a magnetic internal lengthening nail. Does a two-level osteotomy and internal fixation approach provide a reliable result both radiographically and functionally? The average knee extension loss was 12°, LLD 47 mm, PDFA 65°, MAD 2 mm. The patients were treated with an acute, posterior, opening wedge osteotomy of the distal femur stabilized with a lateral plate and screws and grafted with cancellous chips and putty. A second osteotomy was made proximally in the femur percutaneously, and the internal lengthening nail was inserted. Lengthening was done at approximately 1 mm/day. The average extension gain was 12°; amount of lengthening at the proximal site was 40 mm, LLD was 3 mm. The average PDFA was 81°, and MAD 3 mm. There were no complications. Functional results were excellent. Bone healing index was 24 days/cm. The average distance from the distal osteotomy to the joint line was 57 mm. The technique of two-level femur osteotomy stabilized with a plate and lengthening nail yielded excellent results with acceptable correction of deformity, full knee extension, and improved function. There were no complications including implant failure, infection, need for blood transfusion, knee stiffness, nonunion, compartment syndrome, or malunion.
股骨远端的Salter Harris骨折可导致生长紊乱，进而造成腿长不等和膝关节畸形。我们研究了一组（3例）患者，这些患者因股骨远端屈曲畸形愈合和缩短而接受了股骨远端截骨钢板固定术以及使用磁性髓内延长钉的股骨近端截骨术。两级截骨内固定方法在影像学和功能方面是否能提供可靠的结果？平均膝关节伸展损失为12°，下肢长度差异（LLD）为47毫米，近端股骨远端角（PDFA）为65°，机械轴偏差（MAD）为2毫米。患者接受了股骨远端急性、后侧、开放楔形截骨术，并用外侧钢板和螺钉固定，植入松质骨碎块和骨泥。在股骨近端经皮进行第二次截骨，并插入髓内延长钉。延长速度约为每天1毫米。平均伸展增加为12°；近端部位的延长量为40毫米，LLD为3毫米。平均PDFA为81°，MAD为3毫米。无并发症发生。功能结果极佳。骨愈合指数为24天/厘米。远端截骨处至关节线的平均距离为57毫米。采用钢板和延长钉固定的两级股骨截骨技术取得了极佳的效果，畸形矫正可接受，膝关节完全伸展，功能得到改善。未出现包括植入物失败、感染、输血需求、膝关节僵硬、骨不连、骨筋膜室综合征或畸形愈合在内的并发症。
