论文部分内容阅读
[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腘肌腱,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。
[Objective] To explore the clinical effect of proximal tibial osteotomy combined with the long biceps femoris tendon to reconstruct the posterolateral structure of knee joint and to investigate its correction of severe varus deformity in children with sequelae. [Methods] From August 2011 to August 2015, 7 patients with severe genu varus genital sequelae were treated with proximal tibial osteotomy in the first phase. When the second internal fixation was performed, the biceps femoris length Tendon tendon reconstruction of the posterolateral structure of the knee. [Results] All patients were followed up for 20 to 48 months after a proximal tibial osteotomy, with an average of 25.40 months. All the tibiofemoral deformities were corrected in the non-weight-bearing state. The preoperative varus angle was 30 ° ~ 45 ° with an average of 37.10 ° and the varus angle was 8 ° ~ 14 ° with an average of 11.70 ° , Correction angle 20 ° ~ 31 °, an average of 25.4 °, all knee varus deformity improved compared with preoperative. Osteoid bone healing time of 3 to 5 months, an average of 3.50 months. The second postoperative knee reconstruction was followed up for 12 to 24 months. At 12 months postoperatively, there was no varus instability in the full extension of the knee, 30 ° flexion and 1 ° varus instability, 30 ° flexion Side of the lateral rotation of the lower leg increased in 1 case. At 24 months after operation, there was no significant change in the stability of the posteromedial lateral structure, and the strength of the lower limbs recovered satisfactorily. [Conclusion] Proximal tibial osteotomy can correct tibiofemoral deformity and improve knee varus deformity. Reconstruction of the lateral collateral ligament and tendon tendon with the biceps femoris tendon can effectively restore the stability of the posterior lateral knee joint. ; The combination of the two in the nursery sequelae of severe varus deformity correction can achieve better results.