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背景：科德曼悖论揭示了在骨科手术中一种几何学上的误解。在矫形外科的治疗中，如截骨矫正术，医生经常会遇到无法直观理解的情况。在手术过程中，偶尔会有意想不到的成角或旋转畸形的发生。

本研究旨在将骨科医生的注意力引到方向和旋转的概念上，并演示矫形外科治疗后意想不到的畸形的可能性。本研究着重于三种情况：肩部关节，股骨内翻旋转截骨术和股骨去旋转截骨术。

方法：首先，做成一个肩关节模型以计算意想不到的旋转畸形，用来揭示科德曼悖论。其次，股骨内翻去旋转截骨术采用圆筒模型进行模拟演示。第三，重建股骨模型用以在股骨去旋转截骨术中，计算意想不到的成角或旋转畸形。

结果：在肩关节前屈上举和外展后发现了意想不到的外旋。在内翻和去旋转模型中，封闭楔形截骨术和额外的去旋转形成了一个意想不到的外展和外翻畸形，即髋外翻的有根据的矫正。尽管在股骨远端片段去旋转截骨，内翻和外展发生之后，但是这种外展是可以忽视的。

结论：外科手术医生应该意识到，在手术过程后涉及骨区的意想不到的成角畸形。而畸形的程度不同，则取决于外科手术的情况。不过，这项研究揭示了显著的畸形可在骨科手术中，如股骨易变去旋转截骨术得到预示。

Unexpected Angular or Rotational DeformityAfter Corrective Osteotomy

Abstract

Background. Codman s paradox reveals amisunderstanding of geometry in orthopedic practice. Physicians often encountersituations that cannot be understood intuitively during orthopedicinterventions such as corrective osteotomy. Occasionally, unexpected angular orrotational deformity occurs during surgery.

This study aimed to draw the attention oforthopedic surgeons toward the concepts of orientation and rotation anddemonstrate the potential for unexpected deformity after orthopedicinterventions. This study focused on three situations: shoulder arthrodesis,femoral varization derotational osteotomy, and femoral derotation osteotomy.

Methods. First, a shoulder model was generatedto calculate unexpected rotational deformity to demonstrate Codman s paradox.Second, femoral varization derotational osteotomy was simulated using acylinder model. Third, a reconstructed femoral model was used to calculateunexpected angular or rotational deformity during femoral derotation osteotomy.

Results. Unexpected external rotation wasfound after forward elevation and abduction of the shoulder joint. In thevarization and derotation model, closed-wedge osteotomy and additionalderotation resulted in an unexpected extension and valgus deformity, namely,under-correction of coxa valga. After femoral derotational osteotomy,varization and extension of the distal fragment occurred, although theextension was negligible.

Conclusions. Surgeons should be aware ofunexpected angular deformity after surgical procedure involving bony areas. Thedegree of deformity differs depending on the context of the surgical procedure.However, this study reveals that notable deformities can be expected duringorthopedic procedures such as femoral varization derotational osteotomy.