Reif Taylor J, Khabyeh-Hasbani Nathan, Shin Tom Jonggu, Rozbruch S Robert, Fragomen Austin T
Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
HSS J. 2024 Nov;20(4):522-529. doi: 10.1177/15563316231183443. Epub 2023 Jul 1.
Axial malalignment of the bilateral femurs and tibias, previously known as "miserable" malalignment, now renamed tetratorsional malalignment (TTM), presents with hip and/or knee pain refractory to nonoperative treatment.
We sought to investigate whether bilateral rotational osteotomy of the femur and tibia leads to improvement in a deformity-specific patient-reported outcome measure (PROM).
A retrospective review of patients who underwent staged rotational correction of the bilateral femur and tibias was performed. Computed tomography (CT) was used to measure the preoperative rotational profile and plan the surgical correction. Stabilization was predominantly with intramedullary nails. The primary outcome measure was the Limb Deformity-modified Scoliosis Research Society (LDSRS) score. Secondary outcomes included change in mechanical limb alignment and complications of the procedure.
Sixteen patients (13 female and 3 male) with average age of 23.1 years (range: 15-36 years) underwent 4-segment rotational correction. The averages for femoral and tibial deformity correction were 23.5° (6.2° SD) and 20.9° (5.2° SD), respectively. The total LDSRS score improved from 3.67 (0.3 SD) to 4.39 (0.3 SD) ( = .001). The LDSRS sub-scores for function, pain, and self-image also significantly improved. In patients not undergoing concurrent coronal deformity correction, the limb mechanical axis was not significantly changed. No additional procedures were performed to obtain bone union. Three patients required peroneal nerve decompression following the index procedure, and all neurologic symptoms resolved.
This retrospective review suggests that correction of TTM of the lower extremities may lead to improvements in function, pain, and self-image. There were minimal complications and no iatrogenic deformity among 16 patients reviewed. The new diagnosis, TTM, is descriptive of this debilitating condition without communicating a negative patient image.
双侧股骨和胫骨的轴向排列不齐，以前称为“严重”排列不齐，现重新命名为扭转排列不齐（TTM），表现为经非手术治疗难以缓解的髋部和/或膝部疼痛。
我们试图研究股骨和胫骨的双侧旋转截骨术是否能改善特定于畸形的患者报告结局指标（PROM）。
对接受双侧股骨和胫骨分期旋转矫正的患者进行回顾性研究。使用计算机断层扫描（CT）测量术前旋转轮廓并规划手术矫正。主要通过髓内钉进行固定。主要结局指标是肢体畸形改良脊柱侧弯研究学会（LDSRS）评分。次要结局包括肢体机械对线的变化和手术并发症。
16例患者（13例女性和3例男性）平均年龄23.1岁（范围：15 - 36岁）接受了4节段旋转矫正。股骨和胫骨畸形矫正的平均值分别为23.5°（标准差6.2°）和20.9°（标准差5.2°）。LDSRS总分从3.67（标准差0.3）提高到4.39（标准差0.3）（P = .001）。LDSRS功能、疼痛和自我形象的子评分也显著改善。在未同时进行冠状面畸形矫正的患者中，肢体机械轴无明显变化。未进行额外手术以实现骨愈合。3例患者在初次手术后需要腓总神经减压，所有神经症状均得到缓解。
这项回顾性研究表明，下肢TTM的矫正可能会改善功能、疼痛和自我形象。在16例接受评估的患者中，并发症极少，且未出现医源性畸形。新诊断的TTM描述了这种使人衰弱的疾病，而不会传达负面的患者形象。
