Summarize the etiology of O-leg
The most common causes of O-legs can be divided into three categories:
1. Developmental factors: In the physical development period, due to malnutrition or intestinal diseases, lack of nutrients such as calcium and phosphorus, bone development disorder, bone deformation or articular cartilage dysplasia, genu varus changes.
2. Unbalanced factors: due to long-term bad posture or incorrect exertion habits, the muscle mechanics that dominate the joints are out of balance, which can lead to joint displacement and genu varus. This kind of joint displacement is completely different from the well-known joint dislocation. Joint dislocation is characterized by the relative displacement of the corresponding two articular surfaces and the loss of normal correspondence. Joint displacement is mainly manifested in joint rotation and abnormal joint space. When the knees stand parallel and close together, the patella rotates inward, which is caused by the whole rotation of the knee joint, not the subluxation of the patella. As long as the joint is corrected, the patella will return to the front. On the X-ray film, the medial space of the knee joint is not wide, and the medial space is obviously narrowed.
3. O-legs caused by trauma or other diseases.
The medial and lateral collateral ligament of knee joint is a stable structure of medial and lateral angle of knee joint, which can be adjusted adaptively with the change of joint. Under normal circumstances, the medial and lateral collateral ligaments of knee joint are not the key factors to form O-leg, but in some cases, such as trauma leading to injury of lateral collateral ligament, the stability of knee joint will also lead to O-leg, which is more common among athletes. Surgery is usually needed to repair the injured ligament during the treatment.
People with O-legs usually use the muscles on the outside of their legs to exert force when standing and walking, not on the inside. Therefore, the development of leg muscles is asymmetric, often with more lateral muscles and less medial muscles. In this way, the contour lines of leg muscles are curved, giving people the impression that bones are curved. In fact, not all bones are bent, only a few are really bent. If you want to judge whether the bone is bent, the most direct method is to take a positive X-ray.
Moreover, some unbalanced O-shaped legs are accompanied by abduction and displacement of the hip joint, which will lead to a large gap between the legs.
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Examination and diagnosis
Put your feet and palms together, relax your legs and stand up straight. If there is a distance between your knees, you have O-legs.
Generally, the degree of O-leg is judged by two indexes: normal knee distance and active knee distance.
The so-called normal knee distance refers to the distance between the inside of the two knees when the ankles are together and the legs and knees are relaxed.
Active knee distance refers to the distance between two ankles when standing upright, and the leg and knee joint are stressed inward and inside the two knee joints.
According to the normal knee distance and active knee distance, "O-leg" can be divided into mild, moderate and severe.
1, the normal knee distance is less than 3 cm, which is mild;
The normal knee distance between 2.3- 10 cm is moderate;
3. Normal knee distance greater than 10 cm is severe.
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Therapeutic nursing
The corrective methods of O-leg are: manipulation, surgery, instruments, splints, leggings, exercise, correcting insoles and so on.
First, surgical correction
This operation is suitable for patients with very serious O-leg or already complicated with osteoarthritis and joint pain. The advantage of surgery is passive treatment and immediate correction, without perseverance and persistence. The defect is that the surgical techniques are different, and most of them need osteotomy, which is painful, risky and expensive.
1, external fixator plus inverted U-shaped osteotomy of tibial tubercle.
The advantages of this method mainly include: simple and safe osteotomy, fast bone healing, not easy to delay healing, easy to master the angle of plastic correction with external fixator, accurate bone healing angle and easy to adjust. Patients can move on the ground during the treatment, and the muscles of lower limbs will not atrophy.
2. Inverted U-shaped osteotomy of tibial tubercle and external fixation with tubular plaster after operation.
According to statistics, the complete correction rate of O-leg deformity can reach more than 70%.
Second, non-surgical correction methods.
Manipulative correction is used to treat O-leg by correcting joint displacement. The principle of leggings and plus O meters is basically the same, which is to relax the medial collateral ligament of knee joint and restore the stable structure of medial and lateral knee joint. So as to make the tibia rotate outwards and achieve the purpose of correction.
The advantages of non-surgical correction are low cost and low risk, while the disadvantages are active treatment, slow effect and long-term persistence. Without perseverance, it is impossible to achieve the goal of correction.
1. Correct the male splint and leggings.
This method is simple and easy, and the ligament at the knee joint is adjusted by the pressure generated by splint and binding. Its advantages are no need of operation and simple operation. The disadvantage is that you need to persist. Moreover, splint and binding are easy to damage the blood vessels and nerves in the knee joint, and even cause nerve necrosis in severe cases.
2, instrument calibration
The instrument can also adjust the medial and lateral ligaments of the knee joint. The disadvantage is that active treatment is needed, and the length of correction cycle needs to be determined according to the patient's physique and perseverance, which is much higher than the cost of splint and binding. The advantage is that it can avoid damage to the blood vessels and nerves of the knee joint.
Step 3 correct insoles
Orthopedic insole is high outside and low inside. When walking and standing, they can give the calf a force to rotate outward, which can prevent the aggravation and formation of O-shaped legs caused by poor walking posture. It is convenient to use, but it is effective for patients with mild O-leg, not suitable for patients with high O-leg.
Step 4 exercise
The correction method of "O" leg through exercise is as follows:
(1) Stand up straight, put your feet together, bend your knees and do squats and handstands for 20 ~ 3o times each.
(2) Bend down, and make circular movements with both hands and knees to the left and right for 20-30 times.
(3) Keep your feet slightly open, bend over, and tuck your knees in your hands to stop your knees from leaning inward. Stop for 10 second each time and do it for 5 ~ 10 times.
(4) Stand with two feet in parallel. First, take the heel as the axis and do toe abduction and internal rotation; Then do heel abduction and internal rotation 20 ~ 30 times with tiptoe as the axis.
(5) Sit in a chair and try to hold the book with your calf for a while. If you tie your knees with rubber bands, the effect will be more obvious.
(6) Sit on your knees, your waist collapses, your feet slowly move outward, and your waist will gradually straighten. Do 15 ~ 20 times.
(7) Squat down, with hands akimbo, upper body upright, legs apart 15-20cm, toes slightly outward, and slowly squat down with knees together when inhaling, as deep as possible and pause for one minute, feeling leg muscles tense. When exhaling, slowly open your knees, stand up straight and repeat 10 times. Knees and thighs are close together when squatting, which is very effective for correcting O-legs. The lower you squat, the better.
It is very important to prevent O-legs from getting heavier. Except O-legs caused by congenital and organic diseases, most other O-legs are caused by acquired bad habits (kneeling, cross-legged, exercising, walking posture, etc.). ). Pay attention to these in daily life to avoid the formation of O-legs. Even patients who have been corrected by various methods should pay attention to various bad habits to avoid recurrence of leg types.
Third, external fixation therapy.
Knee varus deformity (D, O leg) is a common deformity of lower limbs. Most patients are teenagers, which may involve one or two lower limbs. Pathogenic causes include rickets (divided into children and adolescents), epiphyseal necrosis or epiphyseal dysplasia. Knee varus not only affects the appearance, but also causes the load-bearing line of lower limbs to shift. Over time, it can cause tension side ligament relaxation, pressure side ligament contracture, degenerative arthritis, patella dislocation and patella softening, and can cause various corresponding symptoms. Although it is not difficult to diagnose, it is an important clinical work for orthopedic surgeons to find out the location, direction and severity of deformity and choose appropriate treatment methods.
Older patients with severe deformity often need orthopedic treatment, and the satisfactory orthopedic effect depends on the carefully designed surgical plan before operation. Knee varus with tibial pronation deformity can cause shortening of one limb and short stature on both sides. It should be corrected at the same time during operation. For genu varus caused by special reasons (such as renal rickets with low phosphorus and anti-D), medical treatment is often needed, and osteotomy and orthopedic surgery are feasible after the condition is stable.
Traditional treatment of genu varus often adopts lateral calf incision, wedge osteotomy at the upper end of tibia, oblique osteotomy at different planes of fibula, L-shaped nail plate or Kirschner wire cross internal fixation and plaster external fixation.
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Preventive health care
1, when going up and down the stairs
When going up and down the stairs, you are also very knowledgeable! Snuggle up, climb with your head down, climb with your feet, climb 2-3 squares at a time ... none of this works! This is a great burden on the feet and spine, especially the load-bearing knees and ankles.
Correct posture:
X-leg: Climb stairs with the strength of toes or heels.
O-leg: the waist is straight and the center of gravity falls on the whole sole of the foot.
2. Family sports correction
(1) Relax, hang down your hands naturally and put a towel between your legs.
(2) straighten your back, hold the chair with both hands, hold the towel, and slowly squat down.
(3) Squat down to the sourest part of the leg, stay for 5 seconds, inhale and stand up. Do it 20 times a day.