Frommer Adrien, Laufer Andrea Maria, Toporowski Gregor, Tretow Henning, Rödl Robert, Vogt Björn
Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
Orthopadie (Heidelb). 2024 Sep;53(9):631-645. doi: 10.1007/s00132-024-04546-y. Epub 2024 Aug 22.
Abnormal angular and torsional alignment of the lower extremities during growth are a common reason for consultation of a paediatrician or orthopaedist. There is often uncertainty about the pathological value of these abnormalities and the need for treatment, even among specialists. In the course of physiological growth and development processes, the axial and torsional alignment of the legs sometimes change considerably and in characteristic patterns.
The ability to assess whether abnormal angular or torsional alignments of the lower limb in the course of growth should still be regarded as normal or already as pathological, depending on age and gender, is essential for the treating physician and requires precise knowledge of the physiological development processes and the tolerable limits in all three spatial dimensions.
After careful explanation to the frequently concerned parents, a restrictive approach with observation of the spontaneous course of correction on the basis of regular clinical check-ups makes sense in the majority of cases. Pathological deviations from the physiological conditions are rare overall, can be idiopathic or of secondary origin and should be further clarified diagnostically using imaging procedures. As conservative measures are ineffective, pronounced angular and/or torsional deformities of the legs requiring treatment can only be corrected by surgical intervention, even in children and adolescents. The surgical treatment modalities available are varied and differ in terms of their invasiveness and complication profile, depending on the localization, type and severity of the deformity, as well as the age and possible concomitant diseases of the affected child or adolescent.
在生长过程中，下肢角度和扭转排列异常是儿科医生或骨科医生会诊的常见原因。即使在专家中，对于这些异常的病理价值以及是否需要治疗也常常存在不确定性。在生理生长和发育过程中，腿部的轴向和扭转排列有时会发生相当大的变化，且具有特征性模式。
对于治疗医生而言，根据年龄和性别评估生长过程中下肢异常的角度或扭转排列仍应视为正常还是已属病理状态的能力至关重要，这需要对生理发育过程以及所有三个空间维度的可容忍限度有精确的了解。
在向经常担忧的家长仔细解释后，在大多数情况下，采取一种基于定期临床检查观察自发矫正过程的限制性方法是合理的。总体而言，与生理状况的病理偏差很少见，可能是特发性的或继发性的，应使用成像程序进行进一步的诊断性明确。由于保守措施无效，即使是儿童和青少年，需要治疗的明显腿部角度和/或扭转畸形也只能通过手术干预来矫正。根据畸形的部位、类型和严重程度，以及受影响儿童或青少年的年龄和可能伴随的疾病，可用的手术治疗方式多种多样，其侵入性和并发症情况也各不相同。
