Abraham Edward, Toby David, Welborn Michelle C, Helder Cory W, Murphy Angela
Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL.
The Princess Elizabeth Medical Centre, Port of Spain, Trinidad and Tobago.
J Pediatr Orthop. 2019 May/Jun;39(5):247-256. doi: 10.1097/BPO.0000000000000926.
Successful surgical treatment of late-presenting infantile tibia vara (ITV) patient requires the correction of oblique deformities. The purpose of this study was to report on a new comprehensive approach to correct and prevent recurrence of these deformities with a single procedure.
Medical records of 23 consecutive children (7 to 18 y) with advanced ITV (29 knees) were retrospectively reviewed after a mean of 7.3 years postoperatively (range, 2 to 22 y). Indications for the corrective surgery were any child 7 year or older with a varus mechanical axis angle ≥10 degrees or a varus anatomic axis angle ≥11 degrees and a medial tibial angle (MTA) slope <60 degrees. The deformities were corrected with a dome-shaped osteotomy proximal to the tibial tubercle with a midline vertical extension to the subchondral region of the joint and a lateral hemi-epiphysiodesis.
At latest follow-up, means and medians of each tibial radiographic axis measurement improved significantly from preoperative values (P<0.001): mechanical axis angle from 23 degrees to 4 degrees varus, anatomic axis angle from 25 degrees varus to 1 degree valgus, MTA downward slope from 30 to 78 degrees, posterior MTA from 59 to 80 degrees. In total, 79% and 74% had good to excellent results based on radiographic criteria and clinical questionnaire for satisfaction, pain and function, respectively. Two abnormal medial tibial plateau types were described.
This is the first study to use a single-stage double osteotomy performed proximal to the tibial tubercle for the late-presenting ITV for children 7 years of age or older. In addition to the effective correction of the 4 major tibial deformities, a lateral proximal tibial hemi-epiphysiodesis minimizes recurrence of tibia vara. A contralateral proximal tibial epiphysiodesis is recommended for treated skeletally immature patients with unilateral disease.
Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
成功手术治疗晚期婴儿型胫骨内翻（ITV）患者需要矫正斜形畸形。本研究的目的是报告一种新的综合方法，通过单一手术来矫正并预防这些畸形的复发。
对23例连续的晚期ITV患儿（7至18岁，共29个膝关节）的病历进行回顾性分析，术后平均随访7.3年（范围2至22年）。矫正手术的指征为年龄7岁及以上、内翻机械轴角≥10度或内翻解剖轴角≥11度且胫骨内侧角（MTA）斜率<60度的任何患儿。通过在胫骨结节近端进行穹顶形截骨，并向关节软骨下区域作中线垂直延伸，同时行外侧半骨骺阻滞术来矫正畸形。
在最近一次随访时，各胫骨影像学轴测量的均值和中位数较术前值均有显著改善（P<0.001）：机械轴角从内翻23度改善至内翻4度，解剖轴角从内翻25度改善至外翻1度，MTA向下斜率从30度增至78度，MTA后侧从59度增至80度。根据影像学标准以及关于满意度、疼痛和功能的临床问卷，分别有79%和74%的患者获得了良好至优秀的结果。描述了两种异常的胫骨内侧平台类型。
这是第一项针对7岁及以上儿童晚期ITV采用在胫骨结节近端进行单阶段双截骨术的研究。除了有效矫正4种主要的胫骨畸形外，胫骨近端外侧半骨骺阻滞术可最大程度减少胫骨内翻的复发。对于单侧患病的骨骼未成熟患者，建议对侧胫骨近端骨骺阻滞术。
治疗性IV级。有关证据级别的完整描述，请参阅作者须知。
