Yang S H, Huang S C
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, ROC.
J Formos Med Assoc. 1997 Jan;96(1):36-42.
Congenital coxa vara is a rare disease which can result in a significant disability if untreated or improperly treated. In this retrospective review of eight patients (12 hips) with congenital coxa vara, there were five boys and three girls. Four patients had bilateral involvement and four had unilateral involvement. At the time of surgery, the average age was 7.9 years. All patients underwent valgus intertrochanteric osteotomy with wires or blade-plates for fixation. The mean Hilgenreiner-epiphyseal angle was 75 degrees before surgery and improved to 25 degrees after surgery. The mean neck-shaft angle improved from 95 degrees to 137 degrees immediately after the osteotomies and was 125 degrees at the final follow-up. At a minimum two year follow-up only three hips in three patients maintained more than 80% correction. These three patients all had developmental coxa vara. The acetabular depth improved significantly in the patients with developmental coxa vara, especially in two patients (three hips) who underwent surgery before 6 years of age. Closure of physeal plates was found in three patients (five hips) before surgery and occurred in two patients (two hips) after surgery. After surgery, only two patients had persistent soreness. One patient walked with a limp, and the other, with multiple epiphyseal dysplasia had significant leg length discrepancy. Our results show that valgus osteotomy can correct varus deformities of the proximal femur and improve function. If performed early, it can also prevent the development of hip dysplasia in patients with developmental coxa vara. However, the response of acetabular development was variable in patients with coxa vara due to skeletal dysplasia, despite valgus osteotomy.
先天性髋内翻是一种罕见疾病，若不治疗或治疗不当可导致严重残疾。在这项对8例（12髋）先天性髋内翻患者的回顾性研究中，有5名男性和3名女性。4例为双侧受累，4例为单侧受累。手术时的平均年龄为7.9岁。所有患者均接受了转子间外翻截骨术，并用钢丝或钢板进行固定。术前平均Hilgenreiner骨骺角为75度，术后改善至25度。截骨术后颈干角立即从95度改善至137度，末次随访时为125度。在至少两年的随访中，仅3例患者的3髋维持了超过80%的矫正。这3例患者均为发育性髋内翻。发育性髋内翻患者的髋臼深度显著改善，尤其是2例（3髋）6岁前接受手术的患者。术前在3例患者（5髋）中发现骨骺板闭合，术后在2例患者（2髋）中出现。术后仅2例患者有持续性酸痛。1例患者行走跛行，另1例患有多发性骨骺发育不良，有明显的下肢长度差异。我们的结果表明，外翻截骨术可矫正股骨近端的内翻畸形并改善功能。如果早期进行，还可预防发育性髋内翻患者髋关节发育不良的发生。然而，尽管进行了外翻截骨术，但骨骼发育异常所致髋内翻患者的髋臼发育反应各不相同。
