Shim Jae Woo, Lee Sung-Sahn, Ko Kyung Rae
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Korea.
Clin Orthop Surg. 2024 Dec;16(6):1010-1018. doi: 10.4055/cios24160. Epub 2024 Oct 10.
Different from adults, adolescents with genu varum or valgum can be treated with hemi-epiphysiodesis. We conducted a study to report our recent experience of treating idiopathic genu varum and valgum with clinical relevance to planning of hemi-epiphysiodesis. The aim of this study was to compare the varus and valgus groups focusing on the contribution of the distal femur and proximal tibia to the deformities.
Among patients who visited the outpatient clinic during the recent 4 years, adolescents with genu varum (the varus group) or valgum (the valgus group) greater than 5° were included. The mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA) were measured. The contribution to deformity (%) in each of the distal femur and the proximal tibia was calculated.
One hundred twenty patients and their 120 legs (randomly selected in bilateral cases) were included. In the varus group (n = 51), the mean hip-knee-ankle alignment was varus 7.1° (range, 5.1°-12.1°). The contribution to deformity was 74.1% ± 27.6% at the proximal tibia (MPTA, 81.9° ± 2.0°) and 14.9% ± 25.1% at the distal femur (mLDFA, 88.1° ± 1.7°). In the valgus group (n = 69), the mean alignment was valgus 6.6° (range, 5.1°-11.9°). The contribution was 69.8% ± 30.8% at the distal femur (mLDFA, 82.4° ± 2.1°) and 33.1% ± 27.8% at the proximal tibia (MPTA = 89.2° ± 1.9°). In subgroup analyses, the MPTA was significantly lower in the varus ≥ 8.4° group than the varus < 8.4° group. The mLDFA was significantly lower and the frequency of MPTA > 91.5° was significantly higher in the valgus ≥ 7.7° group than the valgus < 7.7° group.
Genu varum was mainly associated with deformity of the proximal tibia, whereas genu valgum was related to deformities of the distal femur and proximal tibia. Considering the predominant deformity of the proximal tibia, performing hemi-epiphysiodesis only at the proximal tibia is ideal in most adolescents with genu varum.
与成年人不同，患有膝内翻或膝外翻的青少年可采用半骨骺阻滞术进行治疗。我们开展了一项研究，以报告我们近期治疗特发性膝内翻和膝外翻的经验，并阐述其与半骨骺阻滞术规划的临床相关性。本研究的目的是比较膝内翻组和膝外翻组，重点关注股骨远端和胫骨近端对畸形的影响。
在最近4年到门诊就诊的患者中，纳入膝内翻（膝内翻组）或膝外翻（膝外翻组）大于5°的青少年。测量机械性外侧远端股骨角（mLDFA）和内侧近端胫骨角（MPTA）。计算股骨远端和胫骨近端各自对畸形的影响百分比（%）。
纳入120例患者及其120条腿（双侧病例随机选取）。在膝内翻组（n = 51）中，平均髋 - 膝 - 踝对线为内翻7.1°（范围5.1° - 12.1°）。胫骨近端对畸形的影响为74.1% ± 27.6%（MPTA，81.9° ± 2.0°），股骨远端为14.9% ± 25.1%（mLDFA，88.1° ± 1.7°）。在膝外翻组（n = 69）中，平均对线为外翻6.6°（范围5.1° - 11.9°）。股骨远端的影响为69.8% ± 30.8%（mLDFA，82.4° ± 2.1°），胫骨近端为33.1% ± 27.8%（MPTA = 89.2° ± 1.9°）。在亚组分析中，膝内翻≥8.4°组的MPTA显著低于膝内翻<8.4°组。膝外翻≥7.7°组的mLDFA显著更低，且MPTA>91.5°的频率显著高于膝外翻<7.7°组。
膝内翻主要与胫骨近端畸形相关，而膝外翻与股骨远端和胫骨近端畸形有关。考虑到胫骨近端的主要畸形，对于大多数膝内翻青少年，仅在胫骨近端进行半骨骺阻滞术是理想的。
