胫骨髁外翻截骨术联合关节镜下清理术治疗膝关节内翻畸形1例报道

膝关节因外伤或退变等因素发生内翻畸形时，长期异常的负重载荷会加速内侧间室关节软骨的退变，引发膝关节骨性关节炎。胫骨髁外翻截骨术（tibial condylar valgus osteotomy，TCVO）对胫骨内侧平台塌陷具有“跷跷板”效应的膝关节内翻畸形具有很好的治疗效果。本文报道1例经TCVO联合关节镜下清理术治疗Schatzker Ⅳ型胫骨内侧平台陈旧性骨折伴内翻畸形病例。     

Not Kidding! Sequalae of elbow trauma in children

Elbow injuries are common in children and while majority heal very well, some result in deformities of the elbow. Although deformities such as cubitus varus and non-progressive cubitus valgus are considered cosmetic by the paediatric orthopaedic surgeons and intentionally ignored, they are not always benign and can result in functional deficit due to instability, pain, tardy nerve palsies and osteoarthritis later in life. Similarly congenital and developmental conditions that do not cause major functional loss in childhood, become very disabling in adults due to increasing functional demands. Congenital radial head dislocation and radioulnar synostosis fall into this category. In this paper we discuss clinical presentation, treatment options and outcomes of common elbow conditions presenting later in the life.     

Genu varum in children

Genu varum is a relatively common finding in children. There are numerous conditions, both congenital and acquired which can be responsible with varying prognoses and treatments. Physiological bowing is seen most commonly and has a benign course, usually spontaneously resolving with growth. Idiopathic tibia vara (Blount's disease) is the most frequently encountered pathological condition; treatment is dependent on the age of the child and severity of the deformity at presentation. Systemic conditions, most of which also result in short stature can also result in genu varum – these include achondroplasia, rickets, renal osteodystrophy and osteogenesis imperfecta. This article gives an overview of clinical assessment of children presenting with tibial deformity, normal variants and discusses frequently encountered pathology in children with genu varum along with current treatment modalities.     

全膝关节置换后双下肢长度及相关功能变化

文题释义： 膝关节置换：一种治疗膝关节终末期病变的手术方式，可明显减轻患者膝关节疼痛，改善膝关节功能，但尚有约20%患者存在术后不满意情况，需进一步研究加以改善。 下肢全长片：完整呈现全部下肢解剖结构的影像记录方法，可用于评估下肢总体力线(髋膝踝角)及下肢功能长度，为膝关节置换提供术前参考及术后功能评价。 背景：膝关节置换后功能不佳的原因有许多，下肢不等长作为其中的一种，对膝关节置换后功能的影响程度尚未被充分研究。 目的：分析全膝关节置换后患者下肢不等长的变化程度、可能影响因素及功能变化。 方法：收集徐州医科大学附属医院骨科自2016年10月至2018年9月行全膝关节置换患者107例(124膝)，男23例，女84例。单侧全膝关节置换90例(90膝)，双侧全膝关节置换17例(34膝)，其中分次双侧全膝关节置换且间隔时间超过6个月的3例(6膝)并入单膝组；因此单膝组共93例(96膝)，双膝组14例(28膝)。患者对治疗及试验方案知情同意，且得到医院伦理委员会批准。分别于术前、术后10 d及术后6个月拍摄患者站立位下肢全长正位片并测量记录下肢长度及髋膝踝角，大体测量膝关节屈曲挛缩角并记录美国特种外科医院膝关节评分。 结果与结论：①全膝关节置换后患者下肢长度随着畸形矫正而增长，术后6个月下肢长度长于术后10 d，术后10 d 时70.2%的患者下肢增长，术后6个月79.0%的患者肢体增长；②术后10 d及术后6个月时，术后屈曲挛缩角矫正量与术后下肢长度变化量呈正相关；③术侧肢体延长程度与术后美国特种外科医院膝关节评分增量呈正相关；④术前与术后下肢不等长发生率接近，术前为45.1%，术后10 d为 55.3%，术后6个月为46.0%；⑤术前及术后6个月下肢不等长受双下肢畸形差值影响，术前的影响因素为双下肢髋膝踝角差值及双下肢屈曲挛缩角差值；术后6个月时影响下肢不等长的因素是双下肢屈曲挛缩角差值；术前及术后6个月时下肢不等长影响双下肢美国特种外科医院膝关节评分差值。 ORCID: 0000-0002-9642-4136(唐金龙) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

Radiologic Outcomes According to Varus Deformity in Minimally Invasive Surgery Total Knee Arthroplasty

Purpose

To identify the accuracy of postoperative implant alignment in minimally invasive surgery total knee arthroplasty (MIS-TKA), based on the degree of varus deformity.

Materials and Methods

The research examined 627 cases of MIS-TKA from November 2005 to December 2007. The cases were categorized according to the preoperative degree of varus deformity in the knee joint in order to compare the postoperative alignment of the implant: less than 5° varus (Group 1, 351 cases), 5° to less than 10° varus (Group 2, 189 cases), 10° to less than 15° varus (Group 3, 59 cases), and 15° varus or more (Group 4, 28 cases).

Results

On average, the alignment of the tibial implant was 0.2±1.4°, 0.1±1.3°, 0.1±1.6°, and 0.3±1.7° varus, and the tibiofemoral alignment was 5.2±1.9°, 4.7±1.9°, 4.9±1.9°, and 5.1±2.0° valgus for Groups 1, 2, 3, and 4, respectively, in the preoperative stage, indicating no difference between the groups (p>0.05). With respect to the accuracy of the tibial implant alignment, 98.1%, 97.6%, 87.5%, and 86.7% of Groups 1, 2, 3, and 4, respectively, had 0±3° varus angulation, demonstrating a reduced level of accuracy in Groups 3 and 4 (p<0.0001). There was no difference in terms of tibiofemoral alignment, with 83.9%, 82.9%, 85.4%, and 86.7% of each group, respectively, showing 6±3° valgus angulation (p>0.05).

Conclusion

Satisfactory component alignment was achieved in minimally invasive surgery in total knee arthroplasty, regardless of the degree of varus deformity.     

Residual varus alignment after total knee arthroplasty increases knee adduction moment without improving patient function: A propensity score-matched cohort study

BackgroundTargeting residual varus alignment in total knee arthroplasty may be functionally beneficial to preoperative varus patients.MethodsBilateral TKA patients were enrolled. According to the postoperative hip-knee-ankle axis, patients were allocated into residual varus (3° ± 1°) alignment group or neutral (0° ± 1°) alignment group. Then, 1:2 propensity score matching was used to match preoperative variables. Finally, matched neutral (n = 45) and varus groups (n = 32) were followed-up for two years and compared. The primary outcome was the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were range of motion (ROM), Knee Society knee score and function score, spatiotemporal gait parameters, dynamic alignment, knee flexion angle, knee adduction moment (KAM) and internal knee extension moment.ResultsAt two years after surgery, the mean difference of WOMAC score was 0.3 (95% CI, [? 3.1, 3.7]) between the two groups. All secondary outcomes, except KAM and dynamic alignment, showed no significant difference between the two groups. Residual varus alignment group showed increased KAM and maximum KAM was 19% higher (P = 0.006).ConclusionsResidual varus alignment showed no clinical benefits, and both groups of patients had a functionally identical knee gait biomechanics, except for increased KAM and varus alignment. The authors consider that even in patients with varus alignment, the first principle is still achieving neutral alignment, which is helpful for reducing the KAM.Level of evidenceIII, retrospective cohort study.     

Loss of correction in cubitus varus deformity after osteotomy

We aimed to investigate the rate of loss of correction and the factors thereof in pediatric patients undergoing osteotomy for treatment of cubitus varus deformity.Between July 2008 and July 2017, we treated 30 patients who underwent osteotomy for cubital varus. We compared the preoperative and postoperative clinical and imaging findings, including the H-Cobb and Baumman angles, in all patients. Postoperative evaluation was performed by telephonic interviews.Our patients consisted of 17 males and 13 females. The mean age was 75 months. At the first follow-up, approximately 80% of patients had experienced a loss of correction of the humerus-cobb angle (H-Cobb angle); at the second follow-up, the incidence was 83%. Meanwhile, 57% and 43% of patients experienced a loss of correction of the Baumman angle at the first and second follow-ups, respectively. The average interval between the first and second follow-ups was 24 days, and the mean loss in the H-Cobb angle was 2.4°. There was a significant difference between the H-Cobb angles as measured before and after surgery (P < .05). There was no significant difference between the H-Cobb angles of the affected side and the contralateral healthy elbow at the third postoperative follow-up; however, there was a significant difference between the Baumman angle between before and after surgery (P < .05). The Baumman angles as measured at the second and third postoperative follow-ups differed significantly from those of the contralateral healthy elbow joint. According to the survival curve analysis, the median survival times of the H-Cobb and Baumman angles were 27 and 34 months, respectively.The postoperative loss of the 2 angles occurred mainly during the first and second follow-up periods. Therefore, patient follow-up is particularly important in the period directly following the operation. Additional measures may be necessary to avoid rapid angle loss.     

胫骨平台内翻角在预测单纯膝内侧间室骨关节炎患者股骨后髁角中应用的可行性

目的探讨测量胫骨平台内翻角(PTA)预测单纯膝内侧间室骨关节炎患者股骨后髁角(PCA)的可行性。方法回顾性研究。纳入2018年1月—2019年12月哈尔滨医科大学附属第一医院拟行膝关节置换手术的72例单侧单纯膝内侧间室骨关节炎患者的临床资料,其中男7例、女65例,年龄49~80(66.5±14.35)岁,身高155~180(164.3±11.23)cm。72例患者患侧膝均呈内翻畸形,内翻角为10.6°±1.36°。收集患者术前负重位下肢全长X线片与膝关节CT影像资料,在X线片以及冠状位CT图片上测量患者双侧膝关节的PTA、PCA,统计分析患侧、健侧的PTA、PCA差异,采用Pearson相关分析法分别分析患侧、健侧的PTA与PCA之间的相关性。结果72例患者健侧PTA、PCA值分别为3.23°±0.79°、4.64°±1.13°,患侧PTA、PCA值分别为8.39°±1.99°、4.71°±1.15°。健侧PTA明显小于患侧,差异有统计学意义(t=18.916,P<0.01),而健侧与患侧PCA间差异无统计学意义(P>0.05)。Pearson相关分析结果显示,患侧、健侧PTA和PCA均无相关性(r健侧=0.144、r患侧=0.109,P值均>0.05)。结论对于单纯膝内侧间室骨关节炎患者,健侧与患侧的PCA值比较无明显差异,而PTA值则随内侧间室磨损程度的加重而增大,PCA与PTA之间并不存在明显的相关性。术前测量PTA用于预测PCA的方法不可行。     

Ilizarov技术矫正儿童骨骺损伤后踝内翻畸形

儿童踝骨骺损伤后容易遗留踝内翻畸形,导致疼痛、肢体不等长、创伤性关节炎发生。通过微创截骨,根据旋转成角中心(CORA)原则使用Ilizarov环形外固定矫正,能够获得满意的力线和肢体长度,同时能处理其邻近骨、关节和软组织的病变,治疗后踝的外形和功能都非常满意。使用Ilizarov技术矫正此类畸形,可控性好、创伤小、并发症少。