Siffert R S
J Pediatr Orthop. 1982 Mar;2(1):81-5. doi: 10.1097/01241398-198202010-00012.
Tibia vara (Blount's disease) is characterized by two components, the epiphyseal, which is concerned with articular relationships, and physeal/metaphyseal, which may produce angulation of a long bone. Although the initial etiology is not known, it appears that asymmetrical pressure applied to the angulated proximal tibia results in progressive deformity. In the initial stages, medial and posteromedial pressure causes growth retardation of the epiphysis (articular instability) and the physis (tibia vara). Nonsurgical or surgical treatment that relieves the pressure generally permits reconstitution of normal growth. Continued abnormal pressure and shear forces applied to the physis may result in disorderly enchondral ossification and produce a true osteochondrosis, which may lead to permanent physeal arrest. Osteotomy alone to relieve medial pressure may allow the tibia to grow straight, but residual medial epiphyseal compression and joint instability may persist. A case is reported of a 13 1/2 year follow-up of a patient in whom intraepiphyseal osteotomy restored articular congruity without interfering with longitudinal growth. The risks and experimental nature of this procedure are emphasized.
胫骨内翻（布朗特病）有两个特征，一个是与关节关系有关的骨骺部分，另一个是可能导致长骨成角的干骺端/骨骺部分。虽然其初始病因尚不清楚，但似乎施加于成角的胫骨近端的不对称压力会导致进行性畸形。在初始阶段，内侧和后内侧压力会导致骨骺（关节不稳定）和干骺端（胫骨内翻）生长迟缓。减轻压力的非手术或手术治疗通常可使正常生长得以恢复。持续施加于干骺端的异常压力和剪切力可能导致软骨内成骨紊乱，并产生真正的骨软骨病，这可能导致永久性骨骺阻滞。单纯截骨以减轻内侧压力可能会使胫骨伸直生长，但内侧骨骺残余受压和关节不稳定可能会持续存在。本文报告了一例对一名患者进行13年半随访的病例，该患者行骨骺内截骨术恢复了关节一致性，且未干扰纵向生长。强调了该手术的风险和实验性质。
