胫骨近端截骨联合膝关节后外侧重建治疗儿麻后遗症严重膝内翻

发布时间：2018-03-26 20:12

  本文选题：胫骨近端截骨　切入点：膝关节　出处：《中国矫形外科杂志》2017年11期

【摘要】：[目的]胫骨近端截骨术联合采用股二头肌长头腱重建膝关节后外侧结构并探讨其在儿麻后遗症严重膝内翻畸形矫正中的临床效果。[方法]2011年8月~2015年8月对7例儿麻后遗症严重膝内翻畸形患者,一期均行胫骨近端截骨术,二期取内固定时,同时采用股二头肌长头腱重建膝关节后外侧结构。[结果]一期胫骨近端截骨术后均随访20~48个月,平均25.40个月。在非负重状态下,所有胫骨内翻畸形均矫正;在负重状态下,术前膝内翻角度30°~45°,平均37.10°,术后膝内翻角度8°~14°,平均11.70°,矫正角度20°~31°,平均25.4°,所有膝内翻畸形较术前有改善。截骨端愈合时间3~5个月,平均3.50个月。二期膝关节后外侧重建术后随访12~24个月,术后12个月,完全伸膝位无内翻不稳;屈膝30°,Ⅰ度内翻不稳1例;屈膝30°,患侧小腿外旋较健侧增加1例。术后24个月,患膝后外侧结构的稳定性无明显改变,下肢力线恢复满意。[结论]胫骨近端截骨术可以纠正胫骨内翻畸形,改善膝内翻畸形;采用股二头肌长头腱重建膝外侧副韧带和乆肌腱,能够有效恢复膝关节后外侧结构的稳定性;两者联合应用在儿麻后遗症严重膝内翻畸形矫正中可以取得较好疗效。
[Abstract]:[objective] to study the clinical effect of proximal tibial osteotomy combined with long head tendon of biceps femoris for reconstruction of posterolateral structure of knee joint and its application in correction of severe varus genu varus deformity. [methods] from August 2011 to August 2015. A case of severe varus genu deformity after anaesthesia, One stage proximal tibia osteotomy was performed, and the posterior lateral structure of knee joint was reconstructed with the tendon of the long head of biceps femoris muscle. [results] the follow-up of primary proximal tibial osteotomy was 20 ~ 48 months (mean 25.40 months). All tibial varus deformities were corrected under weight-bearing condition, the preoperative knee varus angle was 30 掳/ 45 掳(mean 37.10 掳), the postoperative knee varus angle was 8 掳/ 14 掳(mean 11.70 掳), the corrected angle was 20 掳/ 31 掳(mean 25.4 掳). The average of 3.50 months was 3.50 months. Follow-up for 12 ~ 24 months after secondary posterolateral reconstruction of the knee, 12 months after operation, no varus instability in complete extensor position, 30 掳flexion, 1 case with degree 鈪，

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