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应用 Ilizarov 技术行胫骨高位截骨术治疗成人伴外侧推力的膝内翻畸形:急性矫正及随后逐渐拉紧后外侧膝关节韧带复合体的手术技术及早期疗效

High tibial osteotomy for acute correction and subsequent gradual tensioning of the posterolateral knee ligament complex in treating genu varum combined with a lateral thrust using the Ilizarov technique in adults: surgical technique and early results.

机构信息

Orthopaedic Department, National Institute of Neuromotor System, Cairo, Egypt.

Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, 83523, Egypt.

出版信息

J Orthop Surg Res. 2023 Jun 10;18(1):421. doi: 10.1186/s13018-023-03900-8.

Abstract

OBJECTIVE

To report the early results of using the Ilizarov technique in performing medial wedge opening high tibial osteotomy (MWOHTO) combined with gradual tensioning of the posterolateral corner in adult patients presenting with genu varum (GV) and lateral thrust.

METHODS

A prospective case series study included 12 adult patients with a mean age of 25.2 ± 8.1 years who presented with GV deformity associated with lateral thrust. They were evaluated clinically using the "hospital for special surgery" (HSS) knee scoring system. Radiological evaluation was performed using long film from hip to knee to ankle (HKA) radiographs; the overall mechanical alignment was measured as the HKA angle, the upper tibial deformity was measured as the medial proximal tibial angle (MPTA), and the joint line convergence angle (JLCA) was measured. Surgical technique included using Ilizarov for MWOHTO below the level of the tibial tubercle, acute correction of the GV deformity, fibular osteotomy, and gradual distalization of the proximal fibula.

RESULTS

After a mean follow-up of 26.3 ± 6.4 months, all osteotomies were united. All patients achieved fibular osteotomy site bony union except two with a fibrous union. The HSS score showed improvement from a mean preoperative score of 88.7 ± 7.6 to a postoperative 97.3 ± 3.9 (P < 0.05). The overall mechanical lower limb alignment improved significantly from a mean preoperative HKA of 164.5 ± 3.2 to a postoperative 178.9 ± 1.6 (P < 0.05). The MPTA improved significantly from 74.6 ± 4.1 to 88.9 ± 2.3, as well as the JLCA from 12.17 ± 1.9 to 2.3 ± 1.7 (P < 0.05). Grade 1 pin tract infection was developed in four patients and was treated conservatively. In two patients, mild pain over the fibular osteotomy site was relieved over time. The lateral thrust reoccurred at the last follow-up evaluation in the two poliomyelitis patients.

CONCLUSION

MWOHTO, concomitant with tensioning the knee lateral soft tissue structure at the same setting through applying an Ilizarov apparatus, showed promising functional and radiological outcomes.

摘要

目的

报告使用伊利扎洛夫技术进行内侧楔形切开胫骨高位截骨术(MWOHTO)并逐渐拉紧后外侧角治疗伴有内翻畸形和外侧推力的成人患者的早期结果。

方法

前瞻性病例系列研究纳入了 12 名平均年龄为 25.2±8.1 岁的成人患者,这些患者存在伴有外侧推力的内翻畸形。他们使用“特种外科医院”(HSS)膝关节评分系统进行临床评估。影像学评估采用从髋关节到膝关节到踝关节的长片(HKA)射线照片;整体力学对线测量为 HKA 角,胫骨近端内侧角(MPTA)测量胫骨近端畸形,关节线会聚角(JLCA)测量。手术技术包括使用伊利扎洛夫装置进行胫骨结节以下的 MWOHTO、急性矫正内翻畸形、腓骨切开术和逐渐远移腓骨近端。

结果

平均随访 26.3±6.4 个月后,所有截骨均愈合。所有患者均实现了腓骨切开部位的骨性愈合,除 2 例纤维性愈合外。HSS 评分从术前的 88.7±7.6 分提高到术后的 97.3±3.9 分(P<0.05)。下肢整体力学对线明显改善,从术前的 HKA 平均 164.5±3.2 提高到术后的 178.9±1.6(P<0.05)。MPTA 从 74.6±4.1 显著改善至 88.9±2.3,JLCA 从 12.17±1.9 改善至 2.3±1.7(P<0.05)。4 例患者发生 1 级针道感染,经保守治疗治愈。2 例患者腓骨切开部位轻度疼痛随时间缓解。2 例脊髓灰质炎患者在最后一次随访时出现外侧推力复发。

结论

MWOHTO 联合应用伊利扎洛夫装置同时拉紧膝关节外侧软组织结构,具有良好的功能和影像学结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7faa/10257270/6e696a19f361/13018_2023_3900_Fig1_HTML.jpg

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