Knee valgus osteotomy

Intra-knee and valgus deformity is severe, and the two lower extremities are straight. When the two knees are touching, the distance between the two sides of the unilateral valgus deformity is more than 5cm, and the bilateral malformation is above 10cm; or the two sides are touching each other, and the unilateral varus deformity The distance between the two knees is >5cm; the bilateral deformity is more than 10cm, which may cause orthodontic or knee pain. Treating diseases: knee valgus Indication Intra-knee and valgus deformity is severe, and the two lower extremities are straight. When the two knees are touching, the distance between the two sides of the unilateral valgus deformity is more than 5cm, and the bilateral malformation is above 10cm; or the two sides are touching each other, and the unilateral varus deformity The distance between the two knees is >5cm; the bilateral deformity is more than 10cm, which may cause orthodontic or knee pain. Preoperative preparation 1. Judging the main part of the deformity: Before the operation, it is necessary to judge whether the knee or the valgus is mainly caused by the deformity of the tibia or the femur. If the femoral deformity is the main, femoral osteotomy should be performed; if the humerus is the main, the humerus osteotomy should be performed. A small number of severe deformities, the femoral and tibia are obviously deformed, then the two should be performed with osteotomy, about 8 weeks apart. A simple and effective method of judging is to observe the entire lower limb under fluoroscopy to determine the main part of the deformity. 2. Measure the location of the bone and the angle of the osteotomy: the main body of the bone deformity includes the deformed bone and the upper and lower joints. The joint deformity is mainly composed of the joint and the upper and lower bones. Part of the x-ray film to determine the location of the osteotomy. Deformation of the lower part of the femur: first draw a plane line ab of the knee joint, make a vertical line cd (ie normal force line) at the point, and then make the longitudinal axis ef of a backbone, the angle between the cd and the ef line is the need to correct The angle, that is, the apex angle of the wedge-shaped bone resection (or the apex angle of the wedge-shaped bone graft in the linear osteotomy) [Fig. 1]. The osteotomy plane a'b' (ie, the parallel line of ab) should be selected at the intersection of the cd line and the ef line. The closer the joint is, the more accurate the correction, but it should be at a certain distance from the epiphysis line, and leave the fixed part of the plate to avoid injury to the epiphysis. Generally choose the appropriate part of the metaphysis. The vertical line gh of ef is intersected with a'b' in the lateral cortex of the femur, and the wedge-shaped bone at the angle between the two lines is the bone to be resected. Tibial deformity: the plane line ab and gh of the upper and lower epiphysis of the humerus, the vertical line cd, ef perpendicular to the plane line of each epiphysis at the midpoint of the epiphysis, the intersection point is the plane of the osteotomy, and the angle is The angle that needs to be corrected. 3. Selection of wedge-shaped or wedge-shaped bone graft: wedge-shaped bone-cutting, that is, removing a wedge-shaped bone according to the design, correcting the deformity and restoring the normal force line, the two bone ends can be closely aligned; the wedge-shaped bone graft is a straight line After the bone was cut, the deformity was corrected according to the design, and a wedge-shaped defect was formed between the broken ends of the bone, and the bone was transplanted. Both have their own advantages and disadvantages: after wedge-shaped osteotomy, the limbs are slightly shortened, but there is very little chance of non-healing. After wedge-shaped bone grafting, the limbs grow slightly, but the healing time is longer and may not heal. Craniotomy is often used clinically. Unless the trunk is shorter than the lower extremities, or shorter than the contralateral lower extremity, and the limb malformation is not heavy, it is expected that the bone defect after the osteotomy is not too large, wedge-shaped bone grafting is available. Surgical procedure 1. Position: supine position, the unit is placed with an inflatable tourniquet. 2. Incision, exposure: With the incision of the femur, 6 cm from the iliac crest and 2 cm long longitudinal incision. Incision sartorius muscle and medial femoral muscle gap, pull back the sartorius muscle, identify the saphenous nerve, and extend the finger behind the upper end of the incision, touch the femoral artery pulsation, identify the adductor tube, cut the muscle in front of the femoral artery Floor. The lower part of the femur, the saphenous nerve and the femoral artery and the vein are pulled away from the posterior side, and the medial femoral muscle is pulled forward to reveal the lower part of the femur. If the linear osteotomy is used, the lateral longitudinal incision of the lower part of the femur can also be used. Then the fascia is cut open, the lateral femoral muscle fibers are separated, and the lateral and anterior and posterior femurs are exposed under the periosteum. 3. Cut the bone: Cut the periosteum and peel the lower part of the femur under the periosteum. When peeling the front of the femur, be careful not to damage the sacral sac, and when removing the posterior side of the lower segment, do not damage the iliac vessels and nerves. The humerus plate is then inserted to open the soft tissue to reveal the femur and protect the blood vessels and nerves. The length of the wedge-shaped osteotomy base measured by the x-ray film was drilled by hand on the outer side of the femoral condyle by a wedge-shaped tangential drill, and then cut with a bone knife equal to the anteroposterior diameter of the femur. When cutting the bone, the lateral cortical bone should be cut as much as possible to avoid displacement. After the tourniquet is released, after the hemostasis is completed, the patient is gently adjusted by hand to make the cut bone face in close contact. If a wedge-shaped bone graft is planned, a linear osteotomy will be made. After the correction, the wedge-shaped defect is filled with the cancellous bone from the humerus or the local bone. After checking the deformity correction is satisfactory, suspend the layers layer by layer after the person keeps the alignment. Children were treated with hip-shaped gypsum external fixation after surgery; adults were fixed with steel plate screws or externally with plaster.

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