Oppenheim W L, Fischer S R, Salusky I B
Department of Orthopaedic Surgery, UCLA School of Medicine, USA.
J Pediatr Orthop. 1997 Jan-Feb;17(1):41-9.
Twenty-nine children with renal osteodystrophy (RO) and angular deformities about the knee were studied, including 19 in whom 36 corrective operations were performed. Corrective osteotomy of the distal femur was performed in 20 knees, osteotomy of the proximal tibia in 11 knees, combined femoral/tibial osteotomy in three knees, and medial physeal stapling in two knees. The indication for surgery was a deformity significant enough to interfere with gait. Complications occurred in three patients and recurrence severe enough to require repeated surgery occurred in four patients. Patients who required repeated osteotomy appeared to have had poor metabolic control during the initial surgery, as measured by an increased alkaline phosphatase. Surgery for children with RO and knee deformities is quite feasible but requires careful surgical planning and preoperative metabolic stabilization. Whether to correct the femur or tibia can be determined by evaluating full-length films of the lower extremities.
对29例患有肾性骨营养不良（RO）且膝关节存在角形畸形的儿童进行了研究，其中19例进行了36次矫正手术。20例膝关节进行了股骨远端矫正截骨术，11例膝关节进行了胫骨近端截骨术，3例膝关节进行了股骨/胫骨联合截骨术，2例膝关节进行了内侧骨骺钉合术。手术指征为畸形严重到足以干扰步态。3例患者出现并发症，4例患者复发严重到需要再次手术。通过碱性磷酸酶升高来衡量，需要再次截骨的患者在初次手术期间似乎代谢控制不佳。对患有RO和膝关节畸形的儿童进行手术是相当可行的，但需要仔细的手术规划和术前代谢稳定。通过评估下肢全长片可以确定是矫正股骨还是胫骨。
