varus 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. Treatment of diseases: knee varus 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 to be removed (or the apex angle of the wedge-shaped bone graft in the linear osteotomy). 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 upper thigh is placed in the inflatable tourniquet. 2. Incision, revealed: a longitudinal incision about 5 cm in length on the anterior aspect of the tibia, directly cut into the periosteum. The tibia was removed from the subperiosteum and opened with a humerus plate to protect the surrounding soft tissue. 3. Correction of the osteotomy: According to the planned plane of the osteotomy, drill a row of holes by hand, and then use the bone knife to cut the tibia from the inside to the outside (the outer cortex should not be cut). If the deformity is severe, a small incision should be made on the lateral side of the lower leg to make a slanting cut of the humerus, and then the orthodontic deformity is performed. The connection between the anterior superior iliac spine and the toe and the second toe is determined by the midpoint of the humerus. ), forming a wedge-shaped defect on the inside of the tibia; tightly embedded with a wedge-shaped bone piece taken from the tibia and filling the defect. Gradually loosen the force of the manipulation, such as checking the deformity correction is satisfactory, you can release the tourniquet. After hemostasis, suture layer by layer, and fix it with the front and back long leg plaster. Before the plaster is fixed, the pulsation of the dorsal artery should be examined. Sometimes the limbs grow after the bone cut, which may cause the artery to be stretched, resulting in poor blood supply to the limbs and even necrosis.