Stevens Peter M
Department of Orthopaedics, University of Utah, Salt Lake City, USA.
J Pediatr Orthop. 2007 Apr-May;27(3):253-9. doi: 10.1097/BPO.0b013e31803433a1.
The classic treatment of pathological angular deformities of the extremities is corrective osteotomy; however, osteotomies require hospitalization, pain management, immobilization, and delayed weight bearing. The associated risks, inconvenience, and cost of osteotomy make hemiepiphysiodesis or guided growth an attractive option. Although stapling has a long and proven track record, reported drawbacks related to implant failure, including migration or breakage of staples, have led some to abandon this technique. This report describes a prospective series of 34 consecutive patients who presented with a total of 65 deformities (femur and/or tibia) due to a variety of pathological conditions and who underwent guided growth using a nonlocking extraperiosteal 2-hole plate and screws. This technique relies upon the tension band principle rather than physeal compression. With follow-up ranging from 14 to 26 months (from implantation) in this series, 32 of 34 patients (63 deformity levels) have corrected to neutral at a mean of 11 months and the hardware has been removed. The observed rate of correction was approximately 30% more rapid than noted with stapling, and there have been no permanent growth arrests. Four patients with bilateral idiopathic genu valgum experienced rebound deformity and have since undergone repeat guided growth using the same technique. Only 2 patients with adolescent Blount disease have experienced insufficient correction; each may need a corrective osteotomy of the tibia. Having prevented 63 (97%) of 65 osteotomies in this series of patients, it is evident that guided growth holds promise for postponing if not preventing more invasive surgery.These patients will be observed up to maturity to support my conclusion that the concept of osteotomy as a first resort and criterion standard has become outdated.
肢体病理性角畸形的经典治疗方法是截骨矫正术；然而，截骨术需要住院治疗、疼痛管理、固定以及延迟负重。截骨术相关的风险、不便和成本使得半骨骺阻滞术或引导生长成为一种有吸引力的选择。尽管U型钉固定术有着悠久且经证实的历史记录，但与植入失败相关的报道缺点，包括U型钉移位或断裂，导致一些人放弃了这项技术。本报告描述了一组前瞻性研究，连续34例患者因各种病理状况共出现65处畸形（股骨和/或胫骨），并使用非锁定骨膜外双孔钢板和螺钉进行引导生长。该技术依靠张力带原理而非骨骺加压。在本系列中，随访时间为植入后14至26个月，34例患者中的32例（63个畸形部位）平均在11个月时矫正至中立位，内固定装置已取出。观察到的矫正速度比U型钉固定术快约30%，且未出现永久性生长停滞。4例双侧特发性膝外翻患者出现了反弹畸形，此后使用相同技术再次进行引导生长。只有2例青少年型Blount病患者矫正不足；每人可能需要进行胫骨截骨矫正术。在本系列患者中，65例截骨术中预防了63例（97%），显然引导生长即使不能预防更具侵入性的手术，也有望推迟此类手术。这些患者将被观察至成年，以支持我的结论，即截骨术作为首选和标准术式的观念已经过时。
