Choi I H, Lipton G E, Mackenzie W, Bowen J R, Kumar S J
Alfred I. duPont Institute, Wilmington, Delaware, USA.
J Pediatr Orthop. 2000 Jul-Aug;20(4):428-36.
Fibular hemimelia is associated with an equinovalgus deformity of the foot and ankle and different degrees of wedging of the distal tibial epiphysis. This deformity is often a major problem during lengthening of the shortened tibia. To determine the significance of the wedge-shaped distal tibial epiphysis in the pathogenesis of the equinovalgus deformity of the foot and ankle during and after lengthening, we reviewed 20 patients who had undergone tibial lengthening by either the Wagner or the Ilizarov technique. The mean duration of follow-up after removal of the fixator was 5.2 years (range, 2.3-9.7 years). Three types of wedge-shaped distal tibial epiphyses were identified. A mildly wedged (type I) epiphysis was found in seven patients, a moderately wedged (type II) epiphysis was found in seven patients, and a severely wedged (type III) epiphysis, in six patients. Premature fusion of the lateral part of the distal tibial physis and growth retardation of the tibia were common after lengthening in patients with the type II or type III epiphysis. After lengthening, all patients with a type II or type III epiphysis had a recurrence or aggravation of foot deformities that existed before lengthening. This usually necessitated various secondary operative procedures to obtain a plantigrade foot. We believe that after lengthening, one should anticipate varying degrees of mild growth retardation and minimal foot deformity in patients with type I epiphysis, worsened asymmetric growth retardation and progressive foot deformity in patients with type II epiphysis, and severe growth retardation and severe foot deformity in patients with type III epiphysis.
腓骨半肢畸形与足踝的马蹄内翻畸形以及胫骨远端骨骺不同程度的楔形改变相关。这种畸形在缩短胫骨延长过程中常常是一个主要问题。为了确定胫骨远端楔形骨骺在延长期间及延长后足踝马蹄内翻畸形发病机制中的意义，我们回顾了20例采用瓦格纳（Wagner）或伊里扎洛夫（Ilizarov）技术进行胫骨延长的患者。去除固定器后的平均随访时间为5.2年（范围2.3 - 9.7年）。确定了三种类型的胫骨远端楔形骨骺。7例患者发现轻度楔形（I型）骨骺，7例患者发现中度楔形（II型）骨骺，6例患者发现重度楔形（III型）骨骺。II型或III型骨骺患者延长后，胫骨远端骨骺外侧部分过早融合和胫骨生长迟缓较为常见。延长后，所有II型或III型骨骺患者延长前存在的足部畸形复发或加重。这通常需要进行各种二期手术来获得平足。我们认为，延长后，I型骨骺患者应预期有不同程度的轻度生长迟缓及轻微足部畸形，II型骨骺患者会出现更严重的不对称生长迟缓及进行性足部畸形，III型骨骺患者会出现严重生长迟缓及严重足部畸形。
