EFFECTIVENESS OF Y-SHAPED OSTEOTOMY FOR DEVELOPMENTAL COXA VARA IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ABuLiZiTuErSong , LI Guoqing , ASiKaErMaiMaiTiMing , CAO Li.

Department of Joint Surgery, Orthopedic Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830011, P.R.China. Corresponding author: CAO Li, E-mail: xjbone@21cn.com;

Corresponding author：

Keywords：

Developmental coxa vara; Y-shaped osteotomy; Angle steel plate; Children

DOI：

10.7507/1002-1892.20130144

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Objective To investigate the effectiveness of Y-shaped osteotomy for treatment of developmental coxa vara in children. Methods Between January 2008 and October 2011, 10 cases (14 hips) of developmental coxa vara were treated. There were 4 boys (5 hips) and 6 girls (9 hips), aged 5-12 years (mean, 7.8 years). All the children had obvious lameness and limitations of hip abduction, adduction, and rotation. The anteroposterior pelvic X-ray films showed that the collodiaphysial angle ranged from 46 to 110° (mean, 87°); Hilgenreiner-epiphyseal angle (HE) ranged from 36 to 93° (mean, 57°); and the articulotrochanteric distance (ATD) ranged from — 25 to 6 mm (mean, — 3 mm). The subtrochanteric Y-shaped osteotomy was performed and angle steel plate was used for internal fixation. Results All incisions healed by first intention without surgery-related complication. All cases were followed up 14-40 months (mean, 18 months). The symptom of lameness disappeared or obviously alleviated; the range of motion of hip abduction, adduction, and rotation were increased. Postoperative X-ray films showed that the vertical epiphyseal plate of proximal femur was returned to the horizontal. After operation, the collodiaphysial angle was 130-153° (mean, 137°); HE angle was 23-35° (mean, 27°); and the ATD was 3-22 mm (mean, 14 mm). According to LIU Jiande’s assessment standards, the results were excellent in 5 hips, good in 8 hips, and fair in 1 hip, and the excellent and good rate was 92.8%. The other children had no recurrence of coxa vara except 1 case after 30 months. Conclusion The Y-shaped osteotomy is a simple and effective method to treat developmental coxa vara in children, which can fully correct the deformity, and patients can exercise early because of firm internal fixation.

Citation： ABuLiZiTuErSong,LI Guoqing,ASiKaErMaiMaiTiMing,CAO Li.. EFFECTIVENESS OF Y-SHAPED OSTEOTOMY FOR DEVELOPMENTAL COXA VARA IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(6): 649-652. doi: 10.7507/1002-1892.20130144 Copy

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13.	马军, 张学军, 于凤章, 等. 梯形外展截骨术治疗儿童严重髋内翻. 中华小儿外科杂志, 2001, 22(5): 296-297.
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15.	Trigui M, Pannier S, Finidori G, et al. Coxa vara in chondrodysplasia. J Pediatr Orthop, 2008, 28(6): 599-606.
16.	Pauwels F. Biomechanics of the normal and diseased hip: theoretical foundation, technique and results of treatment. Berlin: Springer-Verlag, 1976: 10-13.
17.	刘如月. 发育性髋内翻的诊断与误诊分析. 中国误诊学杂志, 2008, 4(6): 822-823.
18.	朱明海, 梁国辉, 张天健. 髋臼周围组织松解治疗婴幼儿先天性髋脱位的效果观察. 中国矫形外科杂志, 2009, 14(15): 1191-1193.
19.	吉士俊, 马瑞, 阿良, 等. 髋臼发育不良的临床病理演变规律. 中华骨科杂志, 2007, 21(10): 609-611.
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1. 严世贵, 潘志军. 临床小儿骨科学. 北京: 中国医药科技出版社, 2010: 468.
2. 柏立群, 李远海, 温鑫柱. 先天性髋关节脱位的遗传学研究进展. 中华中医药杂志, 2011, 26(2): 320-321.
3. 姜俊, 麻宏伟, 戴晓梅, 等. 先天性髋关节脱位的遗传流行病学研究. 中国医科大学学报, 2006, 35(5): 514-517.
4. 刘威, 张晓东, 王红超. 改良Pauwels截骨并解剖板内固定治疗先天性髋内翻. 中国矫形外科杂志, 2010, 18(1): 77-78.
5. 李殿国, 王克来, 庄岩. 雌激素受体基因多态性与发育性髋关节脱位关系的研究. 中华小儿外科杂志, 2005, 26(11): 576-578.
6. 黄少云, 张克远, 田百超, 等. 小儿髋关节发育变化的B超动态观测. 新疆医科大学学报, 2003, 26(1): 47-48.
7. 仝允辉, 万富安, 李文霞. Y型截骨术治疗先天性髋内翻. 中国矫形外科杂志, 2007, 15(1): 27-28.
8. 杨启政. 小儿先天性畸形学. 郑州: 河南医科大学, 2007: 436.
9. 刘建德. 先天性髋内翻的手术治疗. 中国矫形外科杂志, 2004, 12(15): 1188-1189.
10. 吉士俊, 潘少川, 王继孟. 小儿骨科学. 济南: 山东科学技术出版社, 1998: 160-163.
11. Ranade A, McCarthy JJ, Davidson RS. Acetabular changes in coxa vara. Clin Orthop Relat Res, 2008, (466): 1688-1691.
12. Sabharwal S, Mittalr R, Cox G. Percutaneous triplanar femoral osteotomy correction for developmental coxa vara: a new technique. J Pediatr Orthop, 2005, 25(12): 28-33.
13. 马军, 张学军, 于凤章, 等. 梯形外展截骨术治疗儿童严重髋内翻. 中华小儿外科杂志, 2001, 22(5): 296-297.
14. 白德明, 王代金, 高书林, 等. 斯坦曼针引导股骨粗隆下外展截骨术治疗先天性髋内翻. 中国药物与临床, 2003, 3(2): 120-121.
15. Trigui M, Pannier S, Finidori G, et al. Coxa vara in chondrodysplasia. J Pediatr Orthop, 2008, 28(6): 599-606.
16. Pauwels F. Biomechanics of the normal and diseased hip: theoretical foundation, technique and results of treatment. Berlin: Springer-Verlag, 1976: 10-13.
17. 刘如月. 发育性髋内翻的诊断与误诊分析. 中国误诊学杂志, 2008, 4(6): 822-823.
18. 朱明海, 梁国辉, 张天健. 髋臼周围组织松解治疗婴幼儿先天性髋脱位的效果观察. 中国矫形外科杂志, 2009, 14(15): 1191-1193.
19. 吉士俊, 马瑞, 阿良, 等. 髋臼发育不良的临床病理演变规律. 中华骨科杂志, 2007, 21(10): 609-611.
20. Terry Canal. 坎贝尔骨科手术学. 卢世璧, 主译. 济南: 山东科学技术出版社, 2006: 1117.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF Y-SHAPED OSTEOTOMY FOR DEVELOPMENTAL COXA VARA IN CHILDREN

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