胫骨高位截骨合并骨膜移植治疗膝关节骨性关节炎

膝关节骨性关节炎十分常见，治疗较为困难。为了提高膝关节骨性关节炎的治疗效果，于１９８８年７月～１９９２年１０月，采用胫骨高位外翻截骨植骨矫正膝关节骨性关节炎膝内翻畸形的同时，用自体骨膜移植治疗髌骨软骨软化症。手术治疗３２例（５１个膝）。经平均５．１年随访，优良率为９０．２％，明显优于各式单纯胫骨高位截骨术。认为，该手术是治疗膝关节骨性关节炎膝内翻畸形伴髌骨软骨软化症的有效方法之一     

胫骨高位截骨治疗膝关节骨性关节炎并内翻畸形

我科于１９８３年在应用胫骨“Ｕ”形截骨术及复位固定器治疗膝内翻［１］的基础上开展了胫骨高位“Ｕ”形截骨、胫骨结节骨端前移及复位固定器固定术治疗膝关节骨性关节炎并内翻畸形，取得了较满意的疗效，现将１９８３～１９９５年治疗的３０例（３５侧膝）中随诊资料完整的２１例（２４侧膝）报告如下。临床资料１．一般资料：本组共２１例（２４侧膝），男４例，女１７例；年龄４８～６９岁。左侧８例，右侧１０例，双侧３例。膝关节痛均以膝前及膝关节内侧疼痛为主，膝关节屈曲挛缩＜１０°。２．站立位膝关节Ｘ线片示膝关节退行性改变…     

胫骨上端套嵌截骨术治疗膝关节畸形60例体会

胫骨上端套嵌截骨术治疗膝关节畸形６０例体会李奎斌我院自１９８５年以来治疗脊髓灰质炎后遗症患者１８０例。对其中膝关节畸形的用胫骨上端套嵌式截骨术进行矫形治疗６０例，效果良好。现将手术方法及主要体会介绍如下。１手术方法先在患肢腓骨中上１／３处截骨，断端咬...     

计算机辅助单一斜形旋转截骨矫正股骨多平面畸形

[目的]介绍斜形单平面旋转截骨术矫正股骨多平面畸形的手术技术和初步临床效果。[方法]对1例股骨骨折畸形愈合患者行上述手术治疗。进行术前设计，确定截骨角度和旋转角度，在Mimics软件上模拟手术，3D打印制作截骨导板，对该病例行斜形单平面旋转截骨手术治疗。取股骨外侧纵行切口，显露畸形部位，安放截骨导板，按术前设计完成截骨、旋转，截骨断端用髓内钉固定，断端取髂骨植骨。[结果]手术过程顺利，术后无不良并发症，术后6个月复查，无跛行，膝关节无疼痛，CT证实骨断端完全愈合。[结论]斜形单平面旋转截骨术切实可行，一次截骨同时矫正股骨在冠状面、矢状面和旋转畸形，短期可取得满意的临床疗效。     

股骨髁上提钩式截骨单钢针固定术

股骨髁上截骨矫治膝关节屈曲畸形一般取“V”形截骨,长腿管形石膏外固定。手术并发症发生率国内文献报道为15.7～41.3％。合并症与石膏固定关系密切。为此我们设计股骨髁上提钩式截骨,单钢针固定术,术后不用石膏固定。通过45例临床观察获得成功。报道如下。 手术方法 取腰麻或骨髓麻醉。在气囊止血带控制下手术,作膝上内侧7cm长斜切口,分层达股骨下     

改良“L”形截骨治疗肘内翻畸形

恢复肘关节的生理力线,矫正异常形态是手术治疗肘内翻畸形的目的。我院自１９８６年３月以来采用改良“Ｌ”形截骨治疗肘内翻１６例,取得满意的效果。１临床资料１１本组１６例,男１４例,女２例;年龄７～１４岁,平均１１２岁;肘内翻１５°～３８°,平均２８?..     

胫骨高位截骨术的远期疗效

目的：了解胫骨高位截骨术治疗膝关节骨关节炎并内翻畸形的远期效果，方法；自１９８５年５月～１９９５年５月施行胫骨高位截骨术６７例（８７膝），其中３８例（４９膝）获得平均５年４个月的随诊。对其疗效进行评价，结果：术后１～５年组优良率为８７．６％，５年以上组优良率为７２％，结论：胫骨高位截骨术治疗膝关节炎并内翻畸形是有效的，它可延缓或免除关节置换术，手术确切重建及术后保持下肢正常力线是提高远期疗效的重要     

膝关节周围截骨术术后超长时间随访报告:最长38年

文章报告了日本横滨市立大学附属医院一组膝关节周围截骨术术后超长时间随访报告.手术原因为"O"腿、"X"形腿、屈曲及旋转畸形等,关于患病原因,通过作者的对比研究和相关检索,发现日本儿童在24个月以内学步者"O"形腿发病率较24个月以后学步者高,因此建议24个月以后学步.一般资料:自1969～1999年,应用膝关节周围截骨术治疗40岁以下膝关节畸形患者共57例72膝.其中12例失随访,45例随访至今.男19例,女26例;共57膝,左侧29膝,右侧28膝.     

下肢长骨骨折旋转畸形及治疗

目的　探讨下肢长骨骨折旋转畸形的临床特点及治疗方法。方法　对 2 4例下肢长骨旋转畸形进行旋转截骨手术治疗 ,1 3例骨干截骨同时进行松质骨植骨 ,膝关节融合和踝关节融合各 1例。结果　随访 6个月～ 5年。术前旋转角度 1 5°～ 4 3°,平均 2 5 3°,矫正到术后 0°～ 1 5° ,平均 9 2°。截骨部位骨折均愈合良好 ,骨愈合时间 3～ 1 0个月 ,平均 5 2个月 ,干骺端截骨较原骨折部位截骨固定平均短 8至 1 2周。 6例膝关节痛者 5例矫形后有明显改善 ,1例有轻度改善。 2例臀中肌步态消失 ;步态明显改善 1 6例 ;轻度改善 4例 ;无改善 2例 (关节融合 )。结论　下肢旋转畸形严重影响到髋关节、膝关节的功能 ,对步态有明显的影响 ,治疗骨折时注意预防。旋转截骨手术是有效的解决方法     

膝骨性关节炎内翻畸形的胫骨高位截骨外固定器治疗的远期疗效分析

我科于 1983年在应用胫骨“Ｕ”形截骨复位外固定器治疗膝内外翻的基础上开展了胫骨高位“Ｕ”形截骨、胫骨结节骨端前移及复位外固定器固定术治疗膝关节骨性关节炎并内翻畸形。现将 1983年 7月～ 1999年 10月治疗的 42例 (4 6膝 )中的随诊达 10年以上资料完整的 17例 (18膝 )报告如下 :1　临床资料本组 17例 (18膝 )年龄 48～ 6 9岁 ,男 1例 ,女 16例。左膝 5例 ,右膝 11例 ,双膝 1例。术前膝关节疼痛均以膝前及膝关节内侧疼痛为主 ,膝关节屈曲挛缩畸形小于 2 0°,关节治疗范围大于 90°。术前站立位膝关节Ｘ线中显示 :膝关节退行性改变主…     

胫骨内侧高位楔形截骨治疗膝关节骨性关节炎

目的　探讨胫骨内侧高位楔形截骨治疗伴有膝内翻畸形的膝关节骨性关节炎的疗效。方法　对 1996年 7月～ 1999年 9月 ,采用胫骨内侧高位楔形截骨结合髂骨植骨钢板内固定术治疗 19例 (2 6膝 )膝关节骨性关节炎伴膝内翻畸形 ,病程 1～ 2 4年 ,平均 6 .3年 ,按 Ahlback分类 度 10膝 , 度 9膝 , 度 6膝 , 度 1膝。患者术前、术后 8周和术后 2年进行患肢全长 X线片检查 ,测量胫股角、胫骨角、股骨角、胫股关节面切线夹角及胫股内侧关节间距大小。按膝关节功能评定标准 ,评定术后膝关节功能恢复情况。　结果　 19例 (2 6膝 )术后获随访 2 4～ 4 5个月 ;术后 2年随访膝关节功能自 (4 8.6± 16 .6 )分增至 (81.7± 14 .8)分 ,胫股内侧关节间距自 (2 .2± 1.6 ) mm增至 (4 .9± 1.5 ) mm,胫股关节面切线夹角自 7.4°± 3.1°减少至 1.7°± 3.1°。植骨愈合满意 ,无膝内翻复发。术中出现关节内骨折 1例 ;皮肤感染 2例。结论　胫骨内侧高位楔形截骨结合植骨钢板内固定 ,可作为治疗伴有膝内翻畸形的膝关节骨性关节炎的有效方法之一。     

股骨远端内翻截骨加交锁髓内钉固定治疗膝外翻畸形

目的　探讨股骨远端内翻截骨加交锁髓内钉固定 ,治疗伴有膝外翻畸形的膝关节骨性关节炎的疗效。方法　 1996年 5月～ 2 0 0 0年 8月 ,采用股骨远端内翻截骨加交锁髓内钉固定治疗 16例 (16膝 )伴膝外翻畸形的膝关节骨性关节炎 ,病程 1～ 2 1年 ,平均 5 .2年。按 Ahlback分类 度 10例 , 度 6例。股骨髁上截骨 11例 ,股骨干远端截骨 5例。术前、术后 8周和 2年均行患肢全长 X线片检查 ,以测量股胫角、胫骨角、股骨角及胫股关节面切线夹角及胫股外侧间距大小。按膝关节功能评定标准 ,评定术后膝关节功能恢复情况。　结果　 16例术后获随访 2 5～ 4 6个月 ,平均 31个月。术后 2年随访骨愈合满意 ,1例延迟愈合 ,为股骨干远端截骨患者。皮肤感染 1例。膝关节功能自 5 0 .4± 15 .9分增至 78.5± 12 .9分 ,胫股关节面切线夹角自 5 .6± 2 .9°减少至 1.6± 3.4°,胫股外侧关节间距自 2 .1± 1.8mm增至 4 .7±1.7m m。　结论　股骨远端内翻截骨加交锁髓内钉内固定 ,可作为治疗伴有膝外翻畸形的膝关节骨性关节炎的有效方法之一。     

“V+L”型胫骨高位截骨加内固定治疗膝内翻的体会

目的应用"V+L"型胫骨高位截骨加钢板内固定手术治疗膝内翻。方法本组35例(56膝),男15例,女20例;年龄46~75岁,平均66.3岁。术前进行相关筛选后,测量出内翻畸形角度,并计算出胫骨结节下"V"型截骨的基底厚度,在胫骨后侧骨皮质不截断,于近端呈"L"型横型截骨,再予以胫骨上端解剖钢板固定。结果本组随访0.5~5年,平均随访3年,效果满意。根据M iller等标准进行功能评价,优27例45膝,良5例8膝,中3例3膝,优良率95%。结论采用"V+L"型胫骨高位截骨加钢板内固定手术治疗膝内翻具有可行性,可获得良好疗效。     

Hemi-wedge osteotomy in the management of large angular deformities around the knee joint

Background

Angular deformity around the knee joint is a common orthopedic problem. Many options are available for the management of such problem with varying degrees of success and failure. The aim of the present study was to assess the results of hemi-wedge osteotomy in the management of big angular deformities about the knee joint.

Materials and methods

Twenty-eight limbs in 21 patients with large angular deformities around the knee joint were treated by the hemi-wedge osteotomy technique. The ages ranged from 12 to 43 years with an average of 19.8 years. The deformity ranged from 20° to 40° with a mean of 30.39° ± 5.99°. The deformities were genu varum in 12 cases and genu valgum in 9 cases. Seven cases had bilateral deformities. Small wedge was removed from the convex side of the bone and put in the gap created in the other side after correction of the deformity.

Results

At the final follow-up, the deformity was corrected in all cases except two. Full range of knee movement was regained in all cases. The complications included superficial wound infection in two cases, overcorrection in one case, pain along the lateral aspect of the knee in one case and recurrence of the deformity in one case. No cases were complicated by nerve injury or vascular injury.

Conclusion

Hemi-wedge osteotomy is a good method for treatment of deformities around the knee joint. It can correct large angular deformities without major complications.

     

A reversed tibial flip autograft technique for correcting over-valgus knee after high tibial closing-wedge osteotomy in total knee arthroplasty

Excessive valgus deformity after a failed high tibial osteotomy presents problems for subsequent total knee arthroplasty because the proximal tibia is deformed, necessitating a much larger resection of bone from the medial aspect of the tibia. Other researchers have reported the tibial flip autograft technique to augment the tibial medial compartment to correct varus knee. We have modified this technique, which we call the reversed tibial flip autograft technique, for a patient with valgus knee after failed high tibial osteotomy. Clinical results were excellent, and no signs of loosening were apparent 2 years after surgery, suggesting that this technique is useful for management of tibial bone loss and correction of valgus angular deformity in total knee arthroplasty.     

改良双侧胫肌延长术的疗效分析

目的 探讨改良双侧胫骨延长术的治疗效果。方法 1997年5月－2000年5月对32例患者行双侧胫骨延长达到增高目的,其中8例膝内翻。手术为颈骨结节下1．0cm处骨膜下横形截断胫骨,腓骨于外踝上10cm水平处横形截断,胫肌骨置入带锁髓内钉,近端上锁,小腿外置延长器,每日缓慢牵伸延长胫骨,达到预期延长目的后2周拆除延长器,同时带锁髓内钉远端上锁,延长段骨质完全愈合约1年后取出带锁髓内钉。结果 32例术后双侧胫骨延长3．5－12．0cm,平均8．5cm,延长时间为53－180天,平均128天,延长段骨痂生长时间为120－270天,平均180天,随访1－3年,患者在增高高度、步态及关节活动度等方面满意率达98％。结论 改良后的双侧胫肌延长术,胫骨骨折愈合时间缩短,并发症少,可同时矫正膝内、外翻畸形。     

Treatment of fixed knee flexion deformity and crouch gait using distal femur extension osteotomy in cerebral palsy

Purpose

The purpose of this study was to evaluate the results of distal femur extension osteotomy and medial hamstring lengthening in the treatment of fixed knee flexion deformity in patients with spastic diparetic cerebral palsy.

Methods

A retrospective study was done in a group of 12 diparetic cerebral palsy patients. A distal femur extension osteotomy was performed as part of multilevel surgery on lower limbs. The fixed knee flexion deformity was measured during physical examination, whereas hip and knee flexion in the stance phase and anterior pelvic tilt were both analyzed at kinematics. The pre- and post-surgery results were compared and analyzed statistically. A medical record review was done in order to identify the complications. The mean follow-up was 28 months.

Results

A significant reduction of fixed knee flexion deformity at physical examination and knee flexion in the stance phase at kinematics was observed, but with no decrease in hip flexion. As a non-desired effect, there was an increase in anterior pelvic tilt after surgical procedures. With regard to complications, a single patient had skin breakdown at a calcaneous area on one side and the recurrence of deformity was seen in 27% of cases.

Conclusions

In this study, in which fixed knee flexion deformity did not exceed 40° before surgery, the distal femur extension osteotomy was effective in increasing knee extension in the stance phase. However, an increase in anterior pelvic tilt, deformity recurrence and necessity for walking aids are possible complications of this procedure.     

Umstellungsosteotomie vs. unikondyläre Prothese bei Gonarthrose

Background

Osteotomy around the knee and unicondylar knee replacement can both produce excellent results in unilateral knee osteoarthritis. The indications for these procedures differ significantly and are discussed in this article.

Methods

A weight-bearing long-leg radiograph, clinical stability tests and varus-valgus-stress radiographs are mandatory for a preoperative analysis. Osteotomy is a safe and reproducible procedure when a biplanar cutting technique is used and fixation is achieved with a plate fixator. Unicondylar knee replacement can be performed minimally invasive with a quadriceps-sparing arthrotomy.

Evaluation

High tibial osteotomy and unicondylar knee may produce good results in unilateral osteoarthritis of the knee. Our multicenter follow-up study with 533 patients revealed good functional outcome scores with a low complication rate. The subjective ratings were better than in comparable groups with unicondylar knee replacement and with total knee arthroplasty.

Conclusions

The main criterium for osteotomy versus unicondylar knee replacement is constitutional deformity of femur or tibia. In constitutional deformity, osteotomy has a very good prognosis. The results are not dependent on age, BMI, or grade of osteoarthritis. Activity and ligament stability of the knee are secondary criteria in favor of osteotomy. Medial osteoarthritis without constitutional deformity should be treated with unicondylar knee replacement.     

Femoral supracondylar focal dome osteotomy with plate fixation for acute correction of frontal plane knee deformity

Focal dome osteotomy (FDO) allows deformity correction without secondary translational deformity. The purpose of this study was to evaluate the degree of correction and knee functional outcome after correction of frontal knee deformity using femoral supracondylar FDO fixed with plate and screws. A prospective study included 12 consecutive cases of femoral frontal plane deformity that underwent correction using supracondylar focal osteotomy fixed by plate and screws. Average age was 27 years, while mean follow-up was 2.1 years. Functional assessment was done using the Hospital for Special Surgery (HSS) knee score. The HSS knee score improved from 85 to 96.8 points. Desired correction was achieved in all cases. Postoperative mechanical axis analysis on long film and scanogram showed no secondary deformity. The overall postoperative mechanical axis was at 3.2 mm medially (range 2–5 mm). Autogenous bone graft was not used in any case, and uneventful osteotomy union was achieved at a mean of 13.8 weeks. Minor complications were encountered in two cases. There were no implant failures or reoperations. Supracondylar FDO of the femur with plate fixation is a reproducible technique that can produce full correction of distal femoral frontal plane deformity, while avoiding creating a secondary deformity. Knee function was improved with good patient satisfaction.