UNASSIGNED: To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents.
UNASSIGNED: The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed. There were 17 males and 6 females, ranging in age from 4 to 16 years with an average of 8.5 years. The time from injury to operation was 1-4 years. The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient\'s upper extremity data at one time, and the preoperative rotation of the distal humerus on the affected side was (33.82±4.39)°. The CT plain scan data were imported into 9yuan3D digital orthopaedic system (V3.34 software) to reconstruct three-dimensional images of both upper extremities. The simulated operation was performed with the healthy upper extremity as the reference, the best osteotomy scheme was planned, overlapped and compared, and the osteotomy guide plate was prepared. The patients were followed up regularly after operation, and the formation of callus in the osteotomy area was observed by X-ray examination. Before and after operation, the carrying angle of both upper extremities (the angle of cubitus valgus was positive, and the angle of cubitus varus was negative) and anteversion angle were measured on X-ray and CT images. At the same time, the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured, and Mayo score was used to evaluate the function of elbow joint.
UNASSIGNED: The operation time ranged from 34 to 46 minutes, with an average of 39 minutes. All patients were followed up 5-26 months, with a mean of 14.9 months. All the incisions healed by first intention after the operation; 2 patients had nail path irritation symptoms after Kirschner wire fixation, which improved after dressing change; no complication such as breakage and loosening of internal fixators occurred after regular X-ray review. Continuous callus formed at the osteotomy end at 4 weeks after operation, and the osteotomy end healed at 8-12 weeks after operation. At last follow-up, the carrying angle, anteversion angle, external rotation range of motion, and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones ( P<0.05). Except for the extension range of motion of the healthy elbow joint ( P<0.05), there was no significant difference in other indicators between the two sides ( P>0.05). At last follow-up, the Mayo elbow score was 85-100, with an average of 99.3; 22 cases were excellent, 1 case was good, and the excellent and good rate was 100%.
UNASSIGNED: Computer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy, which has the advantages of short operation time and easy operation, and the short-term effectiveness is satisfactory.
UNASSIGNED: 探讨基于健侧的计算机模拟截骨联合导板技术治疗青少年肘内翻畸形的可行性及早期临床疗效。.
UNASSIGNED: 回顾分析2019年6月—2023年2月收治且符合选择标准的23例肘内翻畸形患者临床资料。其中男17例，女6例；年龄4～16岁，平均8.5岁。受伤至手术时间1～4年。使用低辐射剂量CT一次性扫描患者双上肢数据，以肱骨头后倾角定义肱骨远端旋转角度，术前患侧肱骨远端旋转（33.82±4.39）°。将CT平扫数据导入9yuan3D数字骨科系统（V3.34）软件，重建双上肢三维图像，以健侧上肢为参考行模拟手术，规划最佳截骨方案，重叠比对，制备截骨导板。术后定期随访，复查X线片观察截骨区骨痂形成情况；手术前后于X线片及CT图像上测量患者双上肢提携角（肘外翻角度为正值，肘内翻角度为负值）、前倾角，同时测量肘关节屈伸活动度及上肢外旋活动度，采用Mayo评分评价肘关节功能。.
UNASSIGNED: 手术时间34～46 min，平均39 min。所有患者均获随访，随访时间5～26个月，平均14.9个月。术后切口均Ⅰ期愈合；2例患者克氏针固定术后出现钉道刺激症状，经换药后好转；定期复查X线片均未发生内固定器械断裂、松动等并发症。术后4周截骨端有连续性骨痂形成，8～12周截骨端愈合。末次随访时，患侧提携角、前倾角、上肢外旋活动度及肘关节伸直、屈曲活动度均较术前显著改善（ P<0.05）；与健侧比较除肘关节伸直活动度差异有统计学意义（ P<0.05）外，其余指标健患侧比较差异均无统计学意义（ P>0.05）。末次随访时，Mayo肘关节评分为85～100分，平均99.3分；获优22例、良1例，优良率100%。.
UNASSIGNED: 基于健侧的计算机模拟截骨联合导板技术治疗青少年肘内翻畸形可实现精准截骨，具有手术时间短、易操作等优势，早期临床效果满意。.

BACKGROUND: Cubitus varus deformity is a complex 3-dimensional deformity. Various osteotomies have been introduced to correct this deformity, however, there is no consensus on the best procedure to correct the deformity while avoiding complications. In this retrospective study, we used a modified inverse right-angled triangle osteotomy to treat 22 children with posttraumatic cubitus varus deformity. The primary objective was to evaluate this technique by presenting its clinical and radiologic results.
METHODS: Twenty-two consecutive patients with a cubitus varus deformity underwent a modified reverse right-angled triangle osteotomy between October 2017 and May 2020 and were then followed for a minimum of 24 months. We evaluated its clinical and radiologic results. Functional outcomes were assessed using Oppenheim criteria.
RESULTS: The average follow-up period was 34.6 months (range, 24.0 to 58.1 months). The mean range of motion was 4.32 degrees (range, 0 degrees to 15 degrees)/122.73 degrees (range, 115 degrees to 130 degrees) (hyperextension/flexion) before surgery and 2.05 degrees (range, 0 degrees to 10 degrees)/127.27 degrees (range, 120 degrees to 145 degrees) at the final follow-up. There were significant ( P < 0.05) differences between the flexion and hyperextension angles before surgery and at the final follow-up. Based on Oppenheim criteria, results were excellent for 20, good for 2, and none of the patients had poor results. The mean humerus-elbow-wrist angle improved from 18.23 degrees (range, 10 degrees to 25 degrees) varus preoperatively to 8.45 degrees (range, 5 degrees to 15 degrees) valgus postoperatively ( P < 0.05). The mean of the preoperative lateral condylar prominence index was 3.52 (range, 2.5 to 5.2) and the average postoperative lateral condylar prominence index was -3.28 (range, -1.3 to -6.0). All patients were pleased with the overall appearance of their elbows.
CONCLUSIONS: The modified reverse right-angled triangle osteotomy can precisely and stably correct the deformity in the coronal and sagittal planes, we recommend this technique as a simple, safe, and reliable correction of cubitus varus deformity.
METHODS: Level IV; case series; therapeutic studies-investigating the results of treatment.

暂无摘要。

UNASSIGNED: To compare the clinical outcomes between patients with moderate and severe slipped capital femoral epiphysis (SCFE) treated with osteotomy at the base of neck and osteoplasty and with healthy individuals.
UNASSIGNED: Comparative cohort with 12 patients (14 hips) with moderate and severe SCFE who underwent osteotomy at the base of neck and osteoplasty between 2007 and 2014. The mean age at surgery was 13.3 ± 2.5 years and the mean follow-up was 3.8 ± 2.2 years. We assessed the level of hip pain by the visual analog scale (VAS) and anterior impingement test (AIT); the level of function using the Harris Hip Score (HHS) and 12-Item Short Form Health Survey (SF-12), the range of motion (ROM) by goniometry and Drehmann sign, and the hip muscular strength by isokinetic and Trendelenburg sign.
UNASSIGNED: The level of pain was slightly higher in the SCFE cohort compared with healthy hips (VAS, 0.8 ± 1.4 vs 0 ± 0, 0.007; AIT, 14% vs 0%, p = 0.06; respectively). No differences were observed between the SCFE and control cohort for the functional scores (HHS, 94 ± 7 vs 100 ± 1, p = 0.135); except for ROM, with increased internal rotation (37.3º ± 9.4º vs 28.7º ± 8.2º, p < 0.001), and strength, with decreased abduction torque (75.5 ± 36.9 Nm/Kg vs 88.5 ± 27.6 Nm/Kg, p = 0.045) in the SCFE cohort.
UNASSIGNED: The osteotomy at the base of neck and the osteoplasty restored the hip motion and muscle strength, except for the abductor strength, to near normal levels, representing a viable option for the treatment of moderate and severe SCFE. Level of Evidence III, Ambidirectional Cohort Study.
UNASSIGNED: Comparar resultados clínicos de pacientes com escorregamento epifisário proximal do fêmur (EEPF) moderado e grave tratados com osteotomia basocervical e cervicoplastia com indivíduos saudáveis.
UNASSIGNED: Coorte comparativa com 12 voluntários saudáveis e 12 pacientes (14 quadris) com EEPF moderado e grave submetidos à osteotomia basocervical e cervicoplastia entre 2007 e 2014. A média de idade na cirurgia foi de 13,3 ± 2,5 anos e o seguimento médio de 3,8 ± 2,2 anos. Avaliou-se nível de dor no quadril utilizando a escala visual analógica (EVA) e o teste de impacto anterior (TIA); nível de função usando o Harris Hip Score (HHS) e o 12-Item Short Form Health Survey (SF-12); amplitude de movimento (ADM) com goniometria e sinal de Drehmann; e força muscular do quadril com dinamômetro isocinético e sinal de Trendelenburg.
UNASSIGNED: O nível de dor foi ligeiramente maior na coorte de EEPF comparado a quadris saudáveis (EVA, 0,8 ± 1,4 vs 0 ± 0, 0,007; TIA, 14% vs 0%, p = 0,06; respectivamente). Não foram observadas diferenças entre os grupos EEPF e controle para os escores funcionais (HHS, 94 ± 7 vs 100 ± 1, p = 0,135), exceto para ADM, com aumento da rotação interna (37,3º ± 9,4º vs 28,7º ± 8,2º, p < 0,001), e força, com diminuição do torque de abdução (75,5 ± 36,9 Nm/Kg vs 88,5 ± 27,6 Nm/Kg, p = 0,045), para o grupo EEPF.
UNASSIGNED: A osteotomia basocervical e a cervicoplastia restauraram o movimento do quadril e a força muscular, com exceção da força abdutora, a níveis próximos do normal, representando uma opção viável para o tratamento de EEPF moderado e grave. Nível de Evidência III, Estudo de Coorte Ambidirecional.

The results of conventional corrective procedures remain suboptimal for severe cubitus varus deformities (> 30°) in children. We present the results of shortening dome osteotomy for the correction of such deformities.
METHODS: We present retrospective review of prospectively collected data of 18 patients (11 boys and 7 girls) who underwent shortening dome osteotomy between January 2011 and December 2019 for severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture. The procedure involved the removal of convexo-concave bone (5-8 mm wide) between the two domes. Humero-ulnar angles, lateral condylar prominence index (LCPI), and elbow range of movements were recorded preoperatively and postoperatively.
RESULTS: Mean age was 7.5 years (range 5 years-11 years). Indication for surgery was poor cosmesis in all the patients and tardy ulnar nerve symptoms in three patients. Mean preoperative humero-ulnar angle was 26.1° varus (range 22°-34°), while it was 7.1° valgus (range 0°-12°) for contralateral normal elbow. They were followed for a mean duration of 2.2 years (range 12 months-5.8 years). The mean postoperative valgus angle achieved was 7.3° (range 2°-12°) as total angular correction achieved was 34.4° (range 30°-44°) (p < 0.001). Radiological healing was observed in all the patients at mean duration of 7.1 weeks (range 5 weeks-9 weeks). Mean preoperative and postoperative LCPI were - 2.4 (range +4.7 to - 10.5) and - 1.7 (range +4.5 to - 5.1), respectively (p = 0.595). Three patients had pin tract infections and two of them responded to aseptic dressings and oral antibiotics, while another required early pin removal and additional protection in splint. All patients regained preoperative arc of motion within 6 months after the procedure.
CONCLUSIONS: Shortening dome osteotomy is a safe and effective method for correcting severe cubitus varus deformities (> 30°) secondary to malunited supracondylar fracture in children.

暂无摘要。

UNASSIGNED: To investigate effectiveness of picture archiving and communication systems (PACS) in lateral wedge osteotomy for cubitus varus deformity in teenagers.
UNASSIGNED: A clinical data of 16 teenagers with cubitus varus deformity between July 2014 and July 2016 was retrospectively analyzed. All patients were treated with lateral wedge osteotomy and fixed with plate. Before operation, the osteotomy design (the osteotomy angle and length) was done in the PACS, including the carrying angle of healthy limb and the varus angle of affected side. There were 10 males and 6 females, with an average age of 11.4 years (range, 10-17 years). The disease duration ranged from 2 to 10 years (mean, 5.6 years). The preoperative X-ray film showed that the supracondylar fractures of the humerus had all healed, and 9 cases had internal rotation deformity; the varus angle of the affected side was 19.5°-33.5°. After operation, the fracture healing and cubitus varus deformity correction were observed by X-ray films, the elbow function was evaluated by Mayo scoring, and the elbow range of motion was detected.
UNASSIGNED: There was no significant difference between the actual intraoperative osteotomy angle and length and the preoperative design ( P>0.05). The hospital stay was 2-8 days, with an average of 4.5 days. No complication such as incision infection or ulnar nerve injury occurred. All 16 cases were followed up 12-18 months, with an average of 14 months. X-ray films showed that the osteotomy healed at 2-7 months after operation, with an average of 2.5 months. The internal fixators were removed within 8-14 months after operation (mean, 12.0 months). X-ray films measurement showed that the carrying angle of the affected side recovered to (10.3±2.0)° at 1 day after operation, which was not significantly different from that of the healthy side [(10.6±1.5)°] before operation ( t=0.480, P=0.637). The carrying angle of the affected side was (9.8±2.6)° at 1 year after operation, which was not significantly different from that of the healthy side [(10.4±1.6)°] at the same time point ( t=0.789, P=0.438). At 1 year after operation, the ranges of flexion and extension of affected side were (131.6±8.4)° and (6.4±2.6)°, respectively; and the ranges of flexion and extension of healthy side were (134.2±6.3)° and (5.9±2.2)°, respectively. There was no significant difference between the healthy and affected sides ( t=1.143, P=0.262; t=0.587, P=0.561). The elbow joint function at 1 year after operation evaluated by Mayo scoring standard rated as excellent in 9 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 93.7%.
UNASSIGNED: Before lateral wedge osteotomy, the PACS is used to design the osteotomy angle and length, which can guide the operation and make the osteotomy more accurate and simple.
UNASSIGNED: 探讨影像存储传输系统（picture archiving and communication systems，PACS）用于青少年肘内翻畸形肱骨外侧楔形截骨矫形术前设计的效果。.
UNASSIGNED: 回顾分析 2014 年 7 月—2016 年 7 月收治的 16 例肱骨髁上骨折后肘内翻畸形青少年患者临床资料，术前均采用 PACS 测量健侧提携角、患侧内翻角，计算截骨角度以及长度，并指导术中操作。男 10 例，女 6 例；年龄 10～17 岁，平均 11.4 岁。病程 2～10 年，平均 5.6 年。术前 X 线片示肱骨髁上骨折均已愈合，其中 9 例伴内旋畸形；患侧内翻角为 19.5°～33.5°。术后定期复查 X 线片，观察骨折愈合及肘内翻畸形矫正情况；采用 Mayo 评分评价肘关节功能，测量肘关节活动度。.
UNASSIGNED: 术中实际截骨角度及长度与术前设计比较，差异均无统计学意义（ P>0.05）。术后住院时间 2～8 d，平均 4.5 d。切口均Ⅰ期愈合，无切口感染及尺神经损伤等并发症发生。16 例均获随访，随访时间 12～18 个月，平均 14 个月。X 线片复查示截骨均获骨性愈合，愈合时间 2～7 个月，平均 2.5 个月。截骨愈合后于 8～14 个月取出内固定物，平均 12.0 个月。X 线片测量示术后 1 d 患侧提携角恢复至（10.3±2.0）°，与术前健侧（10.6±1.5）° 比较差异无统计学意义（ t=0.480， P=0.637）；术后 1 年患侧提携角为（9.8±2.6）°，与同期健侧（10.4±1.6）° 比较差异无统计学意义（ t=0.789， P=0.438）。术后 1 年，患侧肘关节活动范围达屈（131.6±8.4）°、伸（6.4±2.6）°，健侧肘关节分别为（134.2±6.3）°、（5.9±2.2）°，健患侧间比较差异均无统计学意义（ t=1.143， P=0.262； t=0.587， P=0.561）；肘关节功能按 Mayo 评分评定：优 9 例、良 6 例、可 1 例，优良率为 93.7%。.
UNASSIGNED: 青少年肘内翻畸形外侧楔形截骨矫形术前采用 PACS 设计截骨角度及长度，能指导手术操作，使截骨更精确、简便。.

Complex deformities around the knee joint are usually severe and have several aetiologies. They can be present in one or more planes, with variations in severity between planes. The occurrence and progression of the deformity can be influenced by local and systemic factors. Several types of osteotomies and fixation methods are available to correct these complex deformities. The selection of the osteotomy used to correct a deformity depends on the type of deformity, its severity and its aetiology. Therefore, precise planning taking into consideration the above factors is necessary to achieve the goal.
UNASSIGNED: Komplexe Achsdeformitäten sind in der Regel schwer ausgeprägt und haben verschiedene Ursachen. Sie können in einer Ebene oder mehreren Ebenen auftreten, ebenso ist ihre Ausprägung sehr variabel. Die Entstehung und das Fortschreiten der Deformitäten werden möglicherweise von lokalen und systemischen Ursachen beeinflusst. Je nach Deformität, Ausprägung und Ursache werden zur Korrektur komplexer Deformitäten verschiedene Osteotomien verwendet. Die Osteosynthesemöglichkeiten sind vielfältig. Diese Art von Deformitäten benötigt eine gründliche Planung und präzise Ausführung der Korrektur, um das Ziel zu erreichen.

UNASSIGNED: Various osteotomy methods have been proposed in the treatment of cubitus varus. We designed an improved stepped osteotomy to achieve improved deformity correction. We refer to this new approach as double-closed wedge broken-line osteotomy and report a series of clinical and imaging results (deformity correction, range of motion [ROM], function, osteotomy healing, and complications) of patients with cubitus varus treated with this technique.Between July 2014 and July 2019, we treated 9 cases of cubitus varus using the new technique. The study was conducted in accordance with the principles of the Declaration of Helsinki, and the study protocol was approved by the ethics committee of Shenzhen Children\'s Hospital. We obtained written parental consent for the minors before the study was begun. We compared preoperative and postoperative clinical and imaging parameters (humeral elbow-wrist angle, elbow ROM) in all patients. Postoperative evaluation was performed by telephone interview and outpatient review. The median follow-up was 23.2 months (range, 3-63 months).The median humeral elbow-wrist angle modified from -14.27 to 15.15. The median clinical and imaging parameters after correction of deformity were not different from that of the normal side. Using our rehabilitation program, all patients recovered preoperative elbow ROM at the last follow-up.Our double-closed wedge broken-line osteotomy has a larger cancellous bone contact surface. The deformity correction is satisfactory, the osteotomy healing is reliable, and the incidence of complications is low.Level of Evidence: Level IV.

OBJECTIVE: The aim of this study was to determine the intraoperative corrective effect of the aponeurotic release of semimembranosus (SM) as a single procedure or an adjunct procedure to distal myotendinous release of semitendinosus (ST) and myofascial release of SM lengthening in the correction of knee flexion deformity in cerebral palsy (CP).
METHODS: In this prospective study, 46 knees of 23 consecutive ambulatory patients (15 boys and 8 girls; mean age=8.33 years; age range=5-12 years) with spastic diplegic CP with a gross motor function classification system level (GMFCS) II or III were included. The patients were then divided into 2 groups. In group I, there were 10 patients (4 boys, 6 girls; mean age=8.6±2), and combined release of ST in the myotendinous junction and SM in the myofascial junction, followed by aponeurotic release of SM were carried out. In group II, there were 13 patients (2 girls, 11 boys; mean age=8±2.35), and aponeurotic release of SM was done first and followed by the combined release of ST in the distal myotendinous junction and the myofascial release of SM. Intraoperative popliteal angle (PA) measurements were recorded in each group.
RESULTS: PA was reduced from 58.1°±7.6° (range=46°-75°) to 41.2°±8.8° (range=20°-54°) in group 1 and from 59.1°±11.3° (range=40°-87°) to 42.7°±10.8° (range=24°-64°) in group 2. No significant difference was observed between the groups in terms of reduction in PA (p=0.867). In group 1, adding the aponeurotic release of SM further reduced the PA to 31.7°± 8.5° (range=14°-47°) (p=0.002). In group 2, adding the myotendinous release of ST and myofascial release of SM further reduced the PA to 32.9°±7.2° (range=16°-44°) (p=0.004). There was no significant difference between the final PA values in the 2 groups (p=0.662). There was no difference in terms of early complications.
CONCLUSIONS: Aponeurotic release of SM is equally effective to reduce the intraoperative PA with combined myotendinous release of ST and myofascial release of SM. Combining all the 3 procedures provides a better correction without forceful manipulation or lengthening of the lateral hamstrings during the correction of knee flexion deformity in CP.