Delgado E D, Schoenecker P L, Rich M M, Capelli A M
Shriners Hospitals for Crippled Children, St. Louis Unit, Missouri, USA.
J Pediatr Orthop. 1996 Jul-Aug;16(4):484-8. doi: 10.1097/00004694-199607000-00012.
Over a 7-year period (1984-1991), nine patients (aged 10-18 years) with 13 involved extremities were operatively treated for symptomatic severe torsional malalignment of the lower extremity and associated patellofemoral pathology. Physical examination and analysis of gait revealed severe rotational deformity characterized by excessive femoral anteversion and external tibial torsion. The cosmetic and functional pathologic effect of this torsional malalignment was centered about the knee joint. In all patients, conservative treatment, including therapy for muscle strengthening and nonsteroidal medication, was unsuccessful in alleviating suspected patellofemoral pain. Subsequent definitive operative treatment in all 13 extremities consisted of corrective osteotomies, internally rotating the distal part of the tibia or externally rotating the distal part of the femur or both. Osteotomies were performed as close to the knee joint as possible. No additional soft-tissue procedures were performed directly to affect patellar tracking. All osteotomies healed without complications. At an average follow-up of 2 years + 7 months (range, 18-48 months) overall, patients had an improvement in gait pattern, extremity appearance, and a marked decrease in knee pain.
在7年期间（1984 - 1991年），对9例（年龄10 - 18岁）共13个受累肢体的患者进行了手术治疗，这些患者患有有症状的严重下肢扭转排列不齐及相关髌股病变。体格检查和步态分析显示存在严重的旋转畸形，其特征为股骨过度前倾和胫骨外旋。这种扭转排列不齐的美容和功能病理影响集中在膝关节。所有患者采用包括肌肉强化治疗和非甾体类药物治疗在内的保守治疗，均未能缓解疑似髌股疼痛。随后，对所有13个肢体进行的确定性手术治疗包括截骨术，即内旋胫骨远端或外旋股骨远端或两者同时进行。截骨术尽可能靠近膝关节进行。未直接进行额外的软组织手术来影响髌骨轨迹。所有截骨均愈合且无并发症。总体平均随访2年零7个月（范围18 - 48个月），患者的步态模式、肢体外观有所改善，膝关节疼痛明显减轻。
