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采用双平面截骨术成功治疗合并胫骨外旋的膝外翻骨关节炎：一例报告

Successful treatment of valgus knee osteoarthritis involving external tibial torsion with a double level osteotomy: A case report.

作者信息

Murata Shohei, Saito Hidetomo, Saito Kimio, Yamamura Toshiaki, Miyakoshi Naohisa, Shimada Yoichi

机构信息

Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan; Akita Sports Arthroscopy and Knee Group (ASAKG), Akita, Japan.

Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan; Akita Sports Arthroscopy and Knee Group (ASAKG), Akita, Japan.

出版信息

Int J Surg Case Rep. 2020;77:510-514. doi: 10.1016/j.ijscr.2020.11.081. Epub 2020 Nov 19.

DOI:10.1016/j.ijscr.2020.11.081
PMID:33336646
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7700959/
Abstract

INTRODUCTION

Abnormal torsion of the lower leg affects the alignment of the knee joint and foot, and causes impairment of both knee joint function and gait. We here present a successful adult case treated with a double level osteotomy at the distal femur and tibia.

PRESENTATION OF CASE

A 59-year-old woman complained of right knee pain for three years and had a deformity of her right lower limb since childhood. An advanced right tibial external torsion deformity with valgus alignment was revealed. We performed a double level osteotomy to correct both the valgus knee osteoarthritis and the external tibial torsional deformity. At the 2 year follow-up, the patient could run without pain and sit normally.

DISCUSSION

The indications for surgery for abnormal rotation in the lower extremity are also not clear. In addition, most prior surgical reports on torsional deformity of the lower leg have been on childhood cases. Surgical treatment of valgus knee osteoarthritis involving external tibial torsion in adult has been rarely reported.

CONCLUSIONS

In our current report, we present an adult case of valgus knee osteoarthritis involving external tibial torsion that was successfully treated using a double level osteotomy. A longer follow-up is still needed however despite these positive outcomes.

LEVEL OF EVIDENCE

Ⅴ.

摘要

引言

小腿异常扭转会影响膝关节和足部的对线，并导致膝关节功能和步态受损。我们在此介绍一例通过股骨远端和胫骨双平面截骨术成功治疗的成年病例。

病例介绍

一名59岁女性，右膝疼痛3年，自幼右下肢畸形。检查发现右胫骨存在严重的外旋畸形并伴有外翻对线。我们实施了双平面截骨术，以矫正外翻膝骨关节炎和胫骨外旋畸形。在术后2年的随访中，患者能够无痛跑步且坐姿正常。

讨论

下肢异常旋转的手术指征尚不明确。此外，大多数先前关于小腿扭转畸形的手术报告均针对儿童病例。成人外翻膝骨关节炎合并胫骨外旋的手术治疗鲜有报道。

结论

在我们目前的报告中，我们展示了一例成功通过双平面截骨术治疗的成人外翻膝骨关节炎合并胫骨外旋病例。尽管取得了这些积极成果，但仍需要更长时间的随访。

证据级别

Ⅴ级

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/d3481e6df871/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/b3a355d3d9c6/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/0b6dc874ef62/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/e294f994b5ce/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/759bad719792/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/d3481e6df871/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/b3a355d3d9c6/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/0b6dc874ef62/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/e294f994b5ce/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/759bad719792/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a515/7700959/d3481e6df871/gr5.jpg

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本文引用的文献

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Short-Term Results of Hybrid Closed-Wedge High Tibial Osteotomy: A Case Series with a Minimum 3-Year Follow-up.杂交闭合楔形高位胫骨截骨术的短期结果：一项至少随访3年的病例系列研究
Knee Surg Relat Res. 2018 Dec 1;30(4):293-302. doi: 10.5792/ksrr.18.007.
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The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines.SCARE 2018 声明：更新共识手术病例报告（SCARE）指南。
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Relationship Between Coronal Alignment and Rotational Profile of Lower Extremity in Patients With Knee Osteoarthritis.
膝关节骨关节炎患者下肢冠状面对线与旋转特征的关系。
J Arthroplasty. 2018 Dec;33(12):3773-3777. doi: 10.1016/j.arth.2018.07.022. Epub 2018 Jul 30.
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Lower Extremity Abnormalities in Children.儿童下肢异常
Am Fam Physician. 2017 Aug 15;96(4):226-233.
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Does the Surgical Correction of Tibial Torsion with Genu Varum Produce Outcomes Similar to Those in Varus Correction Alone?伴有膝内翻的胫骨扭转手术矫正效果与单纯内翻矫正相似吗？
J Knee Surg. 2018 Apr;31(4):359-369. doi: 10.1055/s-0037-1603797. Epub 2017 Jun 24.
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Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity.外翻膝的几何学：与基于股骨畸形的教条相矛盾。
Am J Sports Med. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Epub 2016 Dec 21.
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Treatment of Varus Ankle Osteoarthritis and Instability With a Novel Mortise-Plasty Osteotomy Procedure.采用新型榫眼成形截骨术治疗内翻型踝关节骨关节炎及不稳
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