Sendner Theresa, Pries Frank, Dickschas Jörg
Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Bugerstr. 80, 96049, Bamberg, Deutschland.
Department Arthroskopische Chirurgie und Sporttraumatologie, Mare Med, Kronshagen, Deutschland.
Oper Orthop Traumatol. 2024 Oct;36(5):257-268. doi: 10.1007/s00064-024-00861-x. Epub 2024 Aug 20.
To treat instability caused by a genu recurvatum using ventral open wedge osteotomy of the distal femur.
Knee instability caused by Genu recurvatum with femoral extension deformity.
Inadequate blood flow to the lower extremity, soft tissue issues, obesity, osteoporosis.
Through a primary medial approach to the distal femur, a ventral open wedge osteotomy is performed using chisel bunch formation and arthrodesis spreader. For symmetrical expansion, another lateral approach at the distal femur and insertion of another arthrodesis spreader is performed. Osteosynthesis was performed with an angle stable plate from the medial side and with additional stabilization using a 4-hole angle stable plate from the lateral side. The osteotomy gap was filled with a bone graft wedge.
Partial weight-bearing of 20 kg was allowed for 6 weeks with passive exercise and lymphatic drainage. A hard frame orthosis for immobilization at 0-10-90° was fitted for 6 weeks. Radiographic controls were performed at 6 weeks, 3 months, and 1 year. After the last radiographic control, hardware was removed.
There are no reports in the current literature regarding the effect of a change in the sagittal plane at the distal femur on alignment, stability, and biomechanics of the knee. This case report shows that genu recurvatum with physiological posterior tibial slope can be successfully treated with anterior femoral flexion osteotomy. Hyperextension was completely eliminated at the follow-up examination after hardware removal after 12 months.
采用股骨远端腹侧开放楔形截骨术治疗膝反屈引起的不稳定。
膝反屈伴股骨伸展畸形导致的膝关节不稳定。
下肢血流不足、软组织问题、肥胖、骨质疏松。
通过股骨远端的初次内侧入路，使用凿束形成和关节固定撑开器进行腹侧开放楔形截骨术。为实现对称扩张，在股骨远端进行另一个外侧入路并插入另一个关节固定撑开器。使用内侧的角度稳定钢板进行骨固定，并使用外侧的4孔角度稳定钢板进行额外固定。截骨间隙用骨移植楔形块填充。
允许部分负重20千克，持续6周，同时进行被动运动和淋巴引流。安装硬框架矫形器，在0-10-90°固定6周。在6周、3个月和1年时进行影像学检查。在最后一次影像学检查后取出内固定物。
目前文献中没有关于股骨远端矢状面变化对膝关节对线、稳定性和生物力学影响的报道。本病例报告表明，具有生理性胫骨后倾坡度的膝反屈可以通过股骨前屈截骨术成功治疗。在12个月后取出内固定物的随访检查中，过伸完全消除。
