下肢多部位截骨结合Ilizarov技术矫正青少年严重膝内翻畸形的应用研究

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摘要目的研究下肢多部位截骨结合Ilizarov技术矫正青少年膝内翻畸形的临床疗效。方法对自2019年9月至2021年3月收入潍坊医学院附属医院矫形骨科的13例(15膝)青少年严重膝内翻患者，行下肢多部位截骨结合Ilizarov外固定架治疗。其中男8例(61.54%)，女5例(38.46%)；年龄9~17岁，平均(13.57±2.71)岁；畸形部位：左膝9侧(60%)，右膝6侧(40%)。比较患者术前、术后3个月、术后6个月以及末次随访时的解剖学股胫角(anatomic femur tibia angle，aFTA)、股骨远端外侧角(lateral distal femoral angle，LDFA)，胫骨近端内侧角(medial proximal tibial angle，MPTA)；术前以及末次随访膝关节活动度、牛津大学膝关节评分(Oxford knee score，OKS)、美国特种外科医院(hospital for special surgery，HSS)膝关节评分。结果 13例(15膝)膝关节畸形患者获得24～39个月随访，平均(29.63±3.29)个月。与术前相比，术后3个月、6个月和末次随访中患者aFTA及LDFA显著减小(P＜0.001)，MPTA显著增大(P＜0.001)。与术前相比，末次随访时患者膝关节活动度未见明显异常(P＞0.05)，OKS显著降低(P＜0.001)，HSS显著提高(P＜0.001)。结论下肢多部位截骨结合Ilizarov技术治疗青少年膝内翻畸形的疗效显著，选择此种治疗方式可获得满意效果。

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	李晓帆
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关键词 ：膝内翻畸形, 青少年, Ilizarov技术, 保膝治疗, 下肢多部位截骨

Abstract：Objective To examine the clinical efficacy of multilevel osteotomy and the Ilizarov technique to correct genu valgum deformities in adolescents.Methods Thirteen adolescents (15 knees) with severe genu valgum deformities were treated with multilevel osteotomy and Ilizarov external fixation apparatus at the Department of Orthopaedics in the Affiliated Hospital of Weifang Medical University between September 2019 and March 2021.8 patients were male (61.54%)，and 5 patients were female (38.46%).Their ages ranged from 9 to 17 years，with an average age of (13.57±2.71)years.The deformities affected the left knee in 9 cases (60%) and the right knee in 6 cases (40%).We compared various parameters，including anatomic femurtibia angle (aFTA)，lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) before the surgery，at 3 months post-surgery，at 6 months post-surgery，and at the last follow-up.Knee joint range of motion，Oxford knee score (OKS)，and hospital for special surgery (HSS) knee-rating scale before surgery and at the last follow-up were also compared.Results Thirteen patients (15 knees) with knee joint deformities were followed up for a duration of 24 to 39 months，with an average follow-up time of (29.63±3.29)months.In comparison to the preoperative measurements，aFTA and LDFA showed significant reductions at 3 months，6 months，and the last follow-up (P＜0.001)，while MPTA significantly increased (P＜0.001).Compared to the preoperative status，the knee range of motion in the patients exhibited no significant abnormalities at the last follow-up (P＞0.05)，the OKS significantly decreased (P＜0.001)，and the score of HSS significantly improved (P＜0.001).Conclusion The use of multilevel osteotomy in combination with the Ilizarov technique demonstrates significant efficacy in treating genu valgum deformities in adolescents.This treatment approach can yield highly satisfactory results.

Key words： knee varus deformity adolescents Ilizarov technique knee-salvage treatment multi-site osteotomy

基金资助:山东省医药卫生科技发展计划项目基金(202004070595)
潍坊市卫生健康委员会科研项目基金(WFWSJK-2022-281)

通讯作者: 钟伟

作者简介: 李晓帆(1995－ )，男，医师，潍坊医学院，17852061619@163.com

引用本文:

李晓帆，梁答，吴明禹，马振，张凯，钟伟. 下肢多部位截骨结合Ilizarov技术矫正青少年严重膝内翻畸形的应用研究[J]. 实用骨科杂志, 2023, 29(11): 975-.
Li Xiaofan，Liang Da，Wu Mingyu，Ma Zhen，Zhang Kai，Zhong Wei. Application of Multi-site Osteotomy Combined with Ilizarov Technique for Correction of Severe Knee Varus Deformity in Adolescents. sygkzz, 2023, 29(11): 975-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I11/975

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