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股骨干骨折畸形愈合伴原位折断的克氏针及内侧间室膝关节关节炎：畸形矫正与膝关节保留

Malunited Femur Shaft with Broken K-Nail In Situ with Medial Compartment Knee Arthritis: Deformity Correction and Knee Preservation.

作者信息

Arora Gaurav, Jolly Angad, Parvir Kuru, Kapoor Sudhir, Kantroo Anshu Anand, Sanduja Kashish

机构信息

Department of Orthopaedics, FMHS SGT University, Gurugram, Haryana, India.

出版信息

J Orthop Case Rep. 2025 Jul;15(7):33-37. doi: 10.13107/jocr.2025.v15.i07.5758.

DOI:10.13107/jocr.2025.v15.i07.5758
PMID:40635952
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12237446/
Abstract

INTRODUCTION

Malunited femur shaft fractures with associated deformities can lead to secondary knee osteoarthritis, often necessitating total knee replacement. Correcting these deformities can offload the knee joint and preserve function.

CASE REPORT

A 53-year-old male presented with a 14-year history of malunited right femur shaft fracture, complicated by a broken K-nail and a 23° varus deformity. He complained of medial knee pain for the past 6 months, with a VAS score of 7. Radiographs revealed Grade 3 medial compartment osteoarthritis. Initially advised total knee replacement, the patient opted for deformity correction with realignment. Surgical management involved two-level femoral osteotomy, implant removal, and fixation with interlocking intramedullary nailing. Post-operative imaging showed normal alignment and significant opening of the medial joint space. The patient's pain decreased to a VAS score of 3, and he began partial weight-bearing on the second post-operative day.

CONCLUSION

Deformity correction through osteotomy and realignment can alleviate knee symptoms and prevent further degenerative changes, thereby preserving the knee joint and avoiding total knee replacement. This approach offers a functional solution for patients with malunited femur fractures and knee arthritis, improving clinical outcomes and quality of life.

摘要

引言

伴有畸形的股骨干骨折不愈合可导致继发性膝关节骨关节炎，常需进行全膝关节置换。矫正这些畸形可减轻膝关节负荷并保留功能。

病例报告

一名53岁男性，有右侧股骨干骨折不愈合14年病史，并发克氏针断裂及23°内翻畸形。他诉说过去6个月膝关节内侧疼痛，视觉模拟评分（VAS）为7分。X线片显示内侧间室3级骨关节炎。最初建议行全膝关节置换，患者选择通过重新对线进行畸形矫正。手术治疗包括两级股骨截骨、取出内固定物以及采用带锁髓内钉固定。术后影像学检查显示对线正常，内侧关节间隙明显增宽。患者疼痛减轻至VAS评分为3分，并在术后第二天开始部分负重。

结论

通过截骨和重新对线进行畸形矫正可缓解膝关节症状并防止进一步的退行性改变，从而保留膝关节并避免全膝关节置换。这种方法为股骨干骨折不愈合和膝关节关节炎患者提供了一种功能性解决方案，改善了临床疗效和生活质量。

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本文引用的文献

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Same-stage total knee arthroplasty and osteotomy for osteoarthritis with extra-articular deformity. Part II: Femoral osteotomy, prospective study of 6 cases.同期全膝关节置换术与截骨术治疗伴关节外畸形的骨关节炎。第二部分：股骨截骨术，6 例前瞻性研究。
Orthop Traumatol Surg Res. 2019 Oct;105(6):1055-1060. doi: 10.1016/j.otsr.2019.04.009. Epub 2019 Jun 14.
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Extra-articular deformities in arthritic knees-a grueling challenge for arthroplasty surgeons: An evidence-based update.关节炎膝关节的关节外畸形——关节置换外科医生面临的严峻挑战：基于证据的最新进展
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Extra-articular deformity is always correctable intra-articularly: in the affirmative.
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Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur.下肢机械轴偏差。胫骨或股骨单顶点角畸形的术前规划。
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