儿童和青少年内侧生长停止所致胫骨远端外伤性内翻畸形的外科矫正:外科技术

IF 0.2 Q4 ORTHOPEDICS Techniques in Orthopaedics Pub Date : 2023-04-01 DOI:10.1097/BTO.0000000000000629
R. Schwartz, P. Kotlarsky, M. Eidelman
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引用次数: 0

摘要

背景:胫骨远端内翻畸形继发于骨骺骨折和部分生长停止是相对常见的。骨骺内侧部分生长停滞导致胫骨远端内翻畸形和腓骨过度生长。如果不及时治疗,这种畸形可能会导致不可逆的损伤和早期踝关节骨关节炎。文献中描述了几种手术技术来实现矫正和预防晚期并发症。这些包括关闭剩余的骨骺和踝关节周围的各种截骨术,使用内固定和外固定。材料和方法:我们报道了一种技术,包括内侧开楔形踝上截骨,插入结构皮质同种异体移植物,用解剖形状的锁定钢板固定,完成胫骨远端物理闭合,以及远端腓骨表面成形术,以防止胫腓骨关系扭曲。该方案的一部分是腓骨远端截骨,以防止距骨承受过大的压力,在手术结束时,还应进行腓骨固定。对于开放性肢体和潜在的显著腿长差异的儿童,我们建议闭合胫骨和腓骨远端对侧肢体。据我们所知,这一协议的具体细节尚未得到描述。结论:我们认为该方案是一种可靠、准确且相对简单的方法,不仅提供踝关节的解剖矫正和修复,以预防早期踝关节和距下关节炎,而且还解决了后期并发症,如同侧腓骨过度生长和肢体长度差异。
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Surgical Correction of Posttraumatic Varus Deformity of the Distal Tibia Due to Medial Growth Arrest in Children and Adolescents: Surgical Technique
Background: Varus deformity of the distal tibia secondary to epiphyseal fracture and partial growth arrest is relatively common. Growth arrest of the medial part of the epiphysis leads to varus deformity of the distal tibia and fibular overgrowth. If the deformity is left untreated, the malalignment may lead to irreversible damage and early ankle joint osteoarthritis in the long term. Several surgical techniques have been described in the literature to achieve correction and prevent late complications. These include the closure of the remaining epiphysis and various osteotomies around the ankle, using internal and external fixation. Materials and Methods: We report a technique that includes medial open wedge supramalleolar osteotomy, insertion of a structural cortical allograft and fixation with an anatomically contoured locking plate, completion of closure of the distal tibial physis, and distal fibular epiphysiodesis to prevent tibiofibular relations distortion. Part of this protocol is osteotomy of the distal fibula to prevent excessive pressure on the talus, and at the end of the operation, fibular fixation should be performed as well. In children with open physis and potential for significant leg length discrepancy, we recommend closure of the contralateral physis of the distal tibia and fibula. To the best of our knowledge, precise details of this protocol have not been described. Conclusion: We believe that this protocol is a reliable, accurate, and relatively simple method that provides not only anatomic correction and restoration of the ankle joint to prevent early ankle and subtalar arthritis but also addresses late complications, such as ipsilateral fibular overgrowth and limb length discrepancy.
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来源期刊
CiteScore
0.60
自引率
0.00%
发文量
31
期刊介绍: The purpose of Techniques in Orthopaedics is to provide information on the latest orthopaedic procedure as they are devised and used by top orthopaedic surgeons. The approach is technique-oriented, covering operations, manipulations, and instruments being developed and applied in such as arthroscopy, arthroplasty, and trauma. Each issue is guest-edited by an expert in the field and devoted to a single topic.
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