Rupprecht Martin, Spiro Alexander S, Rueger Johannes M, Stücker Ralf
Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Germany.
J Pediatr Orthop. 2011 Jan-Feb;31(1):89-94. doi: 10.1097/BPO.0b013e318202c20e.
Ankle valgus in multiple hereditary exostoses (HME) is frequently seen and may result in activity related pain, deformity, or even early degenerative arthritis. Standard treatment protocols do not exist. The effect of medial screw hemiepiphysedesis of the distal tibia to correct ankle valgus is evaluated in this patient population.
A retrospective review of 9 patients with HME and ankle valgus deformity (15 affected extremities) who were treated by a screw hemiepiphyseodesis of the medial physis of the distal tibia is presented. Mean age at time of operation was 11.8 ± 1.6 years (range: 9.6 to 14.7 y). All patients underwent clinical and radiological evaluation. To define the magnitude of ankle valgus we evaluated tibial tilt angle and Malhotra stations preoperatively, at time of screw removal and/or at time of the most recent clinical follow-up.
In 11 extremities the screws were removed after an average time of 22.6 ± 8.0 months (range: 12 to 35 mo) and all patients were examined after a mean time of 36.7 ± 18.7 months after hemiepiphyseodesis (range: 13 to 69 mo). The mean preoperative tibiotalar tilt was 14.3 ± 4.4 degrees (range: 9 to 22 degrees). At time of screw removal the tibiotalar tilt was normalized to 0.4 ± 1.7 degrees (range: -2 to 4 degrees), according to a mean rate of correction of 0.58 ± 0.23 degrees by the month (range: 0.23 ± 0.92 degrees). With follow up 4 ankles demonstrated a change in the fibular station. None of the patients overcorrected into a severe varus, one patient developed a recurrent ankle valgus.
The temporary screw hemiepiphyseodesis of the distal tibial physis is an effective, technically simple, and minimally invasive technique to correct ankle valgus deformity in children with HME.
IV.
多发性遗传性骨软骨瘤（HME）中的踝关节外翻较为常见，可能导致与活动相关的疼痛、畸形，甚至早期退行性关节炎。目前尚无标准的治疗方案。本研究评估了胫骨远端内侧螺钉半骨骺阻滞术对矫正踝关节外翻的效果。
回顾性分析9例患有HME和踝关节外翻畸形的患者（15个患侧肢体），这些患者接受了胫骨远端内侧骨骺的螺钉半骨骺阻滞术。手术时的平均年龄为11.8±1.6岁（范围：9.6至14.7岁）。所有患者均接受了临床和影像学评估。为了确定踝关节外翻的程度，我们在术前、取出螺钉时和/或最近一次临床随访时评估了胫骨倾斜角和马尔霍特拉分期。
11个肢体的螺钉在平均22.6±8.0个月（范围：12至35个月）后取出，所有患者在半骨骺阻滞术后平均36.7±18.7个月（范围：13至69个月）接受检查。术前胫距倾斜平均为14.3±4.4度（范围：9至22度）。取出螺钉时，胫距倾斜恢复正常，为0.4±1.7度（范围：-2至4度），平均每月矫正率为0.58±0.23度（范围：0.23至±0.92度）。随访时，4个踝关节的腓骨位置发生了变化。没有患者过度矫正为严重内翻，1例患者出现复发性踝关节外翻。
胫骨远端骨骺的临时螺钉半骨骺阻滞术是一种有效、技术简单且微创的技术，可用于矫正HME患儿的踝关节外翻畸形。
IV级
