Lim Chaemoon, Shin Chang Ho, Yoo Won Joon, Cho Tae-Joon
Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Korea.
Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Republic of Korea.
J Child Orthop. 2021 Jun 1;15(3):255-260. doi: 10.1302/1863-2548.15.200187.
Surgical correction of proximal tibia deformity in small children can be challenging. We present the surgical technique and outcome of proximal tibia osteotomy fixed with small monolateral external fixator in this patient group.
A total of 17 cases in eight patients younger than nine years of age were study subjects. A proximal tibia osteotomy was fixed with a small monolateral external fixator with or without cross-pinning. Outcome was evaluated by changes of radiographic parameters such as medial proximal tibia angle (MPTA), metaphyseal diaphyseal angle (MDA) and clinical findings of complications, time interval until weight bearing and fixator removal time.
MPTA improved from a preoperative mean of 73° (sd 4°; 66° to 78°) to an immediate postoperative mean of 90° (sd 3°; 85° to 96°) in varus tibiae, and from 104° (sd 1°; 103° to 105°) to 89° (sd 1°; 88° to 89°) in valgus tibiae. In all, 15 of the 17 cases (88.3 %) achieved postoperative MPTA within the normal range (85° to 90°). MDA improved from a preoperative mean of 19° (sd 5°; 11° to 24°) to an immediate postoperative mean of 0° (sd 4°; -6° to 7°) in varus tibiae, and from -25° (sd 2°; -22° to -24°) to 2° (SD 1°; 1° to 3°) in valgus tibiae. Full weight bearing was possible at mean 1.7 months (0.5 to 3.0). Mean follow-up period was 6.5 years (sd 5.4; 1.0 to 16.0). No complications developed during the follow-up.
Proximal tibia osteotomy fixed with small monolateral external fixator provides accurate, safe and efficient correction in the management of coronal plane angular deformity in small children.
Level IV.
小儿近端胫骨畸形的手术矫正具有挑战性。我们在此患者群体中介绍了用小型单侧外固定器固定的近端胫骨截骨术的手术技术及结果。
8例9岁以下患儿共17例纳入研究对象。采用小型单侧外固定器固定近端胫骨截骨术，可加用或不加用交叉克氏针。通过诸如胫骨近端内侧角（MPTA）、干骺端骨干角（MDA）等影像学参数变化以及并发症的临床发现、直至负重的时间间隔和固定器拆除时间来评估结果。
内翻胫骨时MPTA从术前平均73°（标准差4°；66°至78°）改善至术后即刻平均90°（标准差3°；85°至96°），外翻胫骨时从104°（标准差1°；103°至105°）改善至89°（标准差1°；88°至89°）。17例中有15例（88.3%）术后MPTA达到正常范围（85°至90°）。内翻胫骨时MDA从术前平均19°（标准差5°；11°至24°）改善至术后即刻平均0°（标准差4°； -6°至7°），外翻胫骨时从 -25°（标准差2°； -22°至 -24°）改善至2°（标准差1°；1°至3°）。平均1.7个月（0.5至3.0）时可完全负重。平均随访期为6.5年（标准差5.4；1.0至16.0）。随访期间未发生并发症。
用小型单侧外固定器固定的近端胫骨截骨术在小儿冠状面角畸形的治疗中提供了准确、安全且有效的矫正。
四级
