股骨近端内翻截骨术(PFVO)是患有发育性髋关节发育不良(DDH)和Legg-Calvé-Perthes病(LCPD)的儿童的常见手术。然而,PFVO后对膝盖和脚踝角畸形的长期影响仍存在争议。这项研究调查了PFVO与术后膝关节和踝关节对齐变化之间的关系。25例接受PFVO手术的患者纳入研究,评估期至少为4年。其中单侧LCPD14例,单侧DDH11例。手术前收集站立扫描图检查,手术后立即,经过一年的随访,经过3年的随访,最后一次去诊所.射线照相参数包括腿部长度,股骨颈轴角(FNSA),股胫骨角(FTA),机械轴偏差(MAD),胫骨角(TTA),和机械外侧股骨远端角(mLDFA)。在期末考试时,在DDH组中,FNSA显示手术和非手术肢体之间的变化不明显。与术后结果相比,LCPD组FNSA显著改良(p=0.039)。两组TTA均无统计学意义,mLDFA,MAD,和超过5年随访后的腿长度差异。从生物力学的角度来看,脚在腿部质量中心下更多地通过膝盖内侧,膝内翻容易发展。为了纠正机械轴,膝盖逐渐恢复到外翻位置。我们的研究表明,长期随访后,接受PFVO和Pemberton截骨术的LCPD或DDH患者缩小了手术和非手术肢体之间膝盖和脚踝的角度生长间隙。
Proximal femoral varus osteotomy (PFVO) is a common procedure performed in children with developmental dysplasia of the hip (DDH) and Legg-Calvé-Perthes disease (LCPD). However, the long-term effect on angular deformities of the knees and ankles following PFVO remains controversial. This study investigated the relationship between PFVO and alignment changes in the knee and ankle after the procedure. Twenty-five patients undergoing PFVO procedure with a minimum 4-year evaluation period were enrolled in the study, including 14 unilateral LCPD and 11 unilateral DDH. The standing scanogram examinations were collected before the operation, immediately following surgery, after a 1-year follow-up, after a 3-year follow-up, and at the final visit to the clinic. The radiographic parameters included leg length, femoral neck-shaft angle (FNSA), femorotibial angle (FTA), mechanical axis deviation (MAD), tibiotalar angle (TTA), and mechanical lateral distal femoral angle (mLDFA). At the final examination, FNSA demonstrated insignificant change between the operative and non-operative limbs in the DDH group. Compared with the postoperative result, FNSA significantly improved in the LCPD group (p = 0.039). Both groups did not develop statistical significance in TTA, mLDFA, MAD, and leg length discrepancy after more than a 5-year follow-up. From a biomechanical perspective that the foot passes more medial to the knee under the center of leg mass, varus knee was prone to develop. In order to correct the mechanical axis, the knee reverted to a valgus position gradually. Our study indicates that patients with LCPD or DDH receiving PFVO and Pemberton osteotomy narrow the gap of angular growth in knees and ankles between the operative and non-operative limbs after a long-term follow-up.