摘要
[目的]介绍胫骨双段微创截骨Ilizarov技术矫正成人严重膝内翻畸形的手术技术和初步临床结果。[方法]2015年1月—2022年2月应用胫骨双段微创截骨Ilizarov技术治疗19例(26膝)严重膝关节内翻畸形患者。术前根据X线片,确定近端、远端两处成角旋转中心(center of rotation of angulation,CORA)点位置,测量畸形角度,应用微创截骨器于胫骨两处的CORA点位置精准微创截骨,腓骨中远端微创截骨,Ilizarov外固定器固定,术后缓慢调整外固定器矫正畸形,至胫骨近端、远端各角度精确达标。骨愈合后拆外固定器。[结果]所有患者均顺利完成手术,Ilizarov外固定架固定时间平均(4.3±0.8)个月,随访时间平均(35.7±19.7)个月。与术前相比,术后1年KSS临床[分,(29.2±8.4),(70.0±4.1),P<0.001]及KSS功能评分[分,(60.0±8.2),(90.0±8.2),P<0.001]显著改善。影像方面,与术前相比,术后1年胫骨近端内侧角(medial proximal tibial angle,MPTA)[°,(62.8±2.8),(82.4±1.9),P<0.001]、胫骨近端后侧角(posterior proximal tibia angle,PPTA)[°,(64.0±1.6),(79.1±1.0),P<0.001]、胫骨远端外侧角(lateral distal tibial angle,LDTA)[°,(62.8±2.8),(82.4±1.9),P<0.001]均显著改善。[结论]胫骨双段微创截骨Ilizarov技术治疗成年重度膝内翻畸形,能够有效矫正下肢力线,改善膝关节功能,并发症发生率低,临床疗效显著。
[Objective]To introduce the surgical technique and preliminary clinical outcome of Ilizarov technique with minimally inva⁃sive double-segment tibial osteotomy for correcting severe knee varus in adults.[Method]From January 2015 to February 2022,19 pa⁃tients(26 knees)with severe knee varus were treated by Ilizarov technique with minimally invasive double-segment tibial osteotomy.Be⁃fore the operation,the positions of the two angulation rotation centers(center of rotation of angulation,CORA)at the proximal and distal ends of the tibia were determined based on X-ray films with the deformity angles measured.The double minimally invasive osteotomies were performed precisely at the CORA points of the tibia using the minimally invasive osteotomy device,additionally the fibula was also os⁃teotomized with the minimally invasive technique at the middle or distal segment.The Ilizarov external frame was installed individually for fixation and adjustment.After the operation,the external fixator was slowly adjusted to correct the deformity until the tibial alignment re⁃tured to normal.The external frame was removed after bone healing.[Results]All patients underwent the operation and correction success⁃fully with the Ilizarov frame carrying time of(4.3±0.8)months,and followed up for(35.7±19.7)months in a mean.Compared with those be⁃fore the operation,the KSS clinical score[score,(29.2±8.4),(70.0±4.1),P<0.001]and KSS functional score[score,(60.0±8.2),(90.0±8.2),P<0.001]significantly improved one year after the operation.In term of imaging,the medial proximal tibial angle(MPTA)[°,(62.8±2.8),(82.4±1.9),P<0.001],posterior proximal tibia angle(PPTA)[°,(64.0±1.6),(79.1±1.0),P<0.001],and lateral distal tibial angle(LDTA)[°,(62.8±2.8),(82.4±1.9),P<0.001]were significantly improved one year after the operation compared with those preoperatively.[Conclusion]This Ilizarov technique with minimally invasive double-segment tibial osteotomy for correcting severe knee varus in adults does effectively correct the lower limb alignment,improve knee function,with low complication rate and significant clinical efficacy.
作者
韩庆海
杨华清
李强
彭爱民
章耀华
康杰
张鸿悦
赵殿钊
杨云
杨启昌
HAN Qing-hai;YANG Hua-qing;LI Qiang;PENG Ai-min;ZHANG Yao-hua;KANG Jie;ZHANG Hong-yue;ZHAO Dian-zhao;YANG Yun;YANG Qi-chang(Beijing Rehabilitation Hospital,Capital Medical University,Beijing 100144,China)
出处
《中国矫形外科杂志》
2026年第4期367-371,共5页
Orthopedic Journal of China
基金
首都卫生发展科研专项项目(编号:2022-2-2253)。
关键词
成人
膝内翻
双段微创截骨
Ilizarov
技术
外固定
adult
knee varus
double-segment minimally invasive osteotomies
Ilizarov technique
external fixation
