背景:股骨远端截骨术是治疗单室关节炎外翻畸形的一种众所周知且有价值的治疗选择。术后早期并发症众所周知,和风险因素,比如肺部疾病,烟雾,高度依赖的功能状态,和身体质量指数,已经被研究过了,但是,当由于神经退行性疾病导致步态异常或矿物质密度低于正常速度时,没有关于截骨的研究。
方法:我们报告了一名44岁的地中海女性患者,在外侧半月板完全切除后接受了双平面股骨远端开放楔形截骨手术,这导致了随后的侧室骨关节炎和疼痛的发展,尽管有一般的合并症,如多发性硬化症。此外,2个月后,报告了先前应用的Tomofix®钢板上方的股骨髁上骨折。应用LCP髁16孔(336mm)钢板治疗骨折,结构性腓骨移植,和支撑腓骨移植物在相反的一侧。
结论:本病例报告的总体目标是为希望对步态异常的患者进行下肢重新对准手术的外科医生提供一个教训。不仅要考虑机械轴,还有骨密度,病人的步态,和沿骨原料的载荷力分布。关于三维切割导轨的新兴文献没有考虑到这些因素,从而促进所有患者的标准化手术方法。本病例突出显示了由于病理性神经退行性步态而导致的低骨密度和异常力分布的患者。在这种情况下,治疗决策必须仔细考虑原生骨的生物力学脆弱性和矢量力的分布。如果需要截骨术,这些条件必须选择更长的钢板,因为手术更容易失败.
BACKGROUND: Distal femur osteotomies are a well known and valuable treatment option to manage valgus malalignment with unicompartmental arthritis. Early postoperative complications are well known, and risk factors, such as pulmonary diseases, smoke, high dependent functional status, and body mass index, have been studied, but no study is available about osteotomies when gait is abnormal because of neurodegenerative conditions or when mineral density is below the normal rate.
METHODS: We report the
case of a 44 year-old female Mediterranean patient who underwent a biplanar distal femur opening wedge osteotomy surgery following a lateral meniscus total removal, which led to the subsequent development of lateral compartment osteoarthritis and pain, despite general comorbidities, such as multiple sclerosis. Additionally, 2 months later a supracondylar femur fracture above the previously applied Tomofix® plate was reported. Fracture was treated by applying a LCP condylar 16 hole (336 mm) plate, a structural fibular graft, and strut fibular graft on the opposite side.
CONCLUSIONS: The overall aim of this
case report is to provide a lesson to surgeons who want to perform a realignment surgery of the lower limb in patients with abnormal gait. Not only mechanical axes are to be considered, but also bone density, patient\'s gait, and load force distribution along the bone stock. Emerging literature on three-dimensional cutting guides fails to account for these factors, thus promoting a standardized approach to surgery across all patients. The present
case highlights a patient with low bone density and abnormal force distribution resulting from a pathologic neurodegenerative gait. In such cases, treatment decisions must carefully consider the biomechanical vulnerabilities of the native bone and the distribution of vector forces. These conditions must lead the choice toward a longer plate if an osteotomy is indicated, because surgery is more likely to fail.