Inan Muharrem, Chan Gilbert, Bowen J Richard
Department of Orthopedics, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA.
Clin Orthop Relat Res. 2007 Mar;456:164-9. doi: 10.1097/01.blo.0000246560.65714.c8.
Predicting patients' remaining angular growth and timing for hemiepiphysiodesis are crucial for correcting coronal plane knee deformities in children. We asked whether the Angular Deformity Versus Growth Remaining Chart predicted correction of coronal angular deformities of the knee in children. Serial orthoroentgenograms and the predictive chart were used to time percutaneous hemiepiphysiodesis, and the children were followed until skeletal maturity. Twenty-five consecutive children (35 extremities) with a mean skeletal age of 13 years (range, 9.6-16 years) had percutaneous hemiepiphysiodeses as described by Bowen and Johnson, and were followed up until skeletal maturity. At skeletal maturity, correction of varus and valgus coronal plane deformities were within 2 degrees (range, 0 degrees - 6 degrees) of the predicted value. The maximum limb-length discrepancy resulting from the procedure was 1.5 cm. The only complication was failure of a physeal bar formation hemiepiphysiodesis; this was treated successfully with a repeat percutaneous hemiepiphysiodesis. The percutaneous hemiepiphysiodesis is effective and has a low complication rate. Angular correction and timing for hemiepiphysiodesis can be predicted by using the Angular Deformity Versus Growth Remaining Chart in children with coronal plain knee deformities.
预测患儿剩余的角度生长情况以及半骨骺阻滞术的时机，对于矫正儿童膝关节冠状面畸形至关重要。我们探讨了角度畸形与剩余生长图表能否预测儿童膝关节冠状面角度畸形的矫正情况。采用连续的X线片和预测图表来确定经皮半骨骺阻滞术的时机，并对患儿进行随访直至骨骼成熟。25例连续患儿（35个肢体），平均骨骼年龄为13岁（范围9.6 - 16岁），按照Bowen和Johnson的描述进行了经皮半骨骺阻滞术，并随访至骨骼成熟。在骨骼成熟时，内翻和外翻冠状面畸形的矫正情况在预测值的2度范围内（范围0度 - 6度）。该手术导致的最大肢体长度差异为1.5厘米。唯一的并发症是半骨骺阻滞术导致的骨骺条形成失败；通过再次经皮半骨骺阻滞术成功治疗。经皮半骨骺阻滞术有效且并发症发生率低。对于冠状面膝关节畸形的儿童，使用角度畸形与剩余生长图表可以预测半骨骺阻滞术的角度矫正情况和时机。
