股骨远端骨折术后膝内翻的手术治疗策1选读.doc

股骨远端骨折术后膝内翻的手术治疗策略 surgical treatment of genu varum after distal femur fracture operation 杜义江1，李波2，陈静1，肖长义1 1.三峡大学医学院形态学部，443002；2.宜昌市长航医院骨外科，443003. 目的　探讨股骨远端骨折术后并发膝内翻的手术处理。方法　分析回顾本院2000年10月~2010年10月45例并发膝内翻病例手术治疗效果，45例（45膝）膝内翻患者（我院行股骨远端骨折术后并发膝内翻的33例，收治外院手术后并发膝内翻的12例）， 45例膝关节内翻患者35例采取股骨髁上截骨+软组织松解术+锁定加压钢板内固定术作为一组，10例行全膝关节置换术（ＴＫＡ）作为另外一组，术前、术后均行患肢负重位X线片检查,根据测量股胫角、内翻角及胫股关节面切线夹角、膝关节HSS评分评定标准,评估两组手术方式膝关节功能恢复情况。结果： 45例膝关节内翻患者均获得随访，时间8~90(40±3·5)个月，术后出现切口感染1例，为迟发性感染,经清创后痊愈。术后内翻矫正43膝,仍有膝内翻2膝,内翻角分别为3°、5°。末次随访时,截骨组X线检查截骨骨性愈合， HSS膝关节评分由术前23~56(41±3.2 )分提高到78~91(86.5±3.8)分；TKA组X线检查未见假体松动、感染，HSS膝关节评分由术前19~57(38.0±4.1 )分提高到76~89(86.2±4.3)分。结论发生膝内翻患者无论是采取股骨髁上截骨术和软组织松解术或全膝关节置换术手术，都能取得较好的临床效果，但尽量行前者手术，为患者二期行全膝关节置换术留下空间。 关键词：股骨远端骨折 膝关节内翻 手术治疗 截骨 全膝关节置换术 Objective: To investigate the surgical treatment of genu varum after distal femur fracture operation. Methods: the therapeutic effect of 45 cases with genu varum. In the 45 cases, 35 patients as the osteotomy group underwent supracondylar osteotomy, limited?soft?tissue?release (LSTR) combined with internal fixation with steel plate, 10 patients as the TKA group underwent total knee replacement (TKA). Femorotibial angle, varus angle and femorotibial articular surface tangent angle were measured and compared pre- and post-operation, and functional recovery was evaluated by knee joint HSS. Results: 45 cases with genu varum were followed up for 8 to 90 months(mean 40). In the 45 cases, there is 1 incision infection which cured after debridement, there are 43 cases were corrected, there are 2 cases remain deformity with varus angle of 3° and 5° respectively. In the last follow-up visit , All of 35 cases in osteotomy group achieved clinical bone healing, HSS score increased from 23~56(41±3.2 ) to78~91(86.5±3.8) (P0·05). No prosthesis loose or infection occurred in TKA group, HSS score increased from 19~57(38.0±4.1 ) to 76~89(86.2±4.3)(P0·05). Conclusion: All the patients in osteotomy group and TKA group can obtain fine clinical resul