Stevens Peter M, Kennedy Jason M, Hung Man
Department of Orthopaedics, University of Utah, Salt Lake City, UT 84113, USA.
J Pediatr Orthop. 2011 Dec;31(8):878-83. doi: 10.1097/BPO.0b013e318236b1df.
Ankle valgus may be insidious and common in a variety of congenital conditions including clubfoot, neuromuscular disorders and others or acquired after fracture, osteotomies, or other manipulations of the lower extremity. This can cause hindfoot pronaton, resulting in lateral impingement and excessive shoe wear. Orthoses do not change the natural history. Medial hemiepiphysiodesis of the tibia is an accepted method of correcting this problem. Difficulties with transmalleolor screw removal prompted us to adopt the tension band method. Our purpose was to outline the technique of using guided growth with a medial tension band plate and discuss the efficacy of this technique.
We undertook this retrospective review of 33 patients (57 ankles) who underwent guided growth to correct ankle valgus and were followed until attaining full correction or skeletal maturity. Most of the implants were removed when the ankle was neutral to 5 degrees of varus overcorrection. We obtained weightbearing anteroposterior radiographs of the ankles preoperatively, just before plate removal, and at final follow-up, measuring the lateral distal tibial angle and noting the fibular station. We documented the rate of correction and related complications.
The average age at surgery was 10.4 years (range, 6.1 to 14.6 y) and an average follow-up was 27 months (range, 12 to 57.5 mo). The lateral distal tibial angle improved from an average of 78.7 to 90 degrees at implant removal and measured 88.2 degrees at final follow-up. The rate of correction was calculated to be 0.6 degrees per month. The fibular station remained the same in 36 of 57 ankles and improved in 15 ankles. There were 2 cases of skin breakdown complicated by infection. There were no instances of hardware failure, excessive varus, or premature physeal closure and no patient has required an osteotomy.
Without appropriate radiographs, ankle valgus may be mistaken for hindfoot valgus and mismanaged accordingly. Guided growth of the distal medial tibia has become our treatment of choice for ankle valgus in the growing child or adolescent. Use of plate epiphysiodesis is safe, well tolerated, may readily be combined with other treatments, and provides a rate of correction comparable to the transmalleolar screw method.
IV, retrospective review, no control series.
踝关节外翻在多种先天性疾病（包括马蹄内翻足、神经肌肉疾病等）中可能隐匿且常见，也可在下肢骨折、截骨术或其他手术操作后出现。这会导致后足旋前，进而引起外侧撞击和鞋子过度磨损。矫形器无法改变其自然病程。胫骨内侧半骨骺阻滞术是矫正该问题的一种公认方法。经内踝螺钉取出困难促使我们采用张力带方法。我们的目的是概述使用内侧张力带钢板进行引导性生长的技术，并探讨该技术的疗效。
我们对33例（57个踝关节）接受引导性生长以矫正踝关节外翻的患者进行了回顾性研究，并随访至完全矫正或骨骼成熟。当踝关节处于中立位至5度内翻过度矫正时，大多数植入物被取出。我们在术前、取出钢板前及最终随访时获取踝关节负重前后位X线片，测量胫骨远端外侧角并记录腓骨位置。我们记录了矫正率及相关并发症。
手术平均年龄为10.4岁（范围6.1至14.6岁），平均随访时间为27个月（范围12至57.5个月）。胫骨远端外侧角在取出植入物时从平均78.7度改善至90度，最终随访时为88.2度。计算得出矫正率为每月0.6度。57个踝关节中有36个踝关节的腓骨位置保持不变，15个踝关节有所改善。有2例皮肤破损并发感染。未出现内固定失败、过度内翻或骨骺过早闭合的情况，且没有患者需要进行截骨术。
若无适当的X线片，踝关节外翻可能被误诊为后足外翻并得到错误处理。胫骨远端内侧的引导性生长已成为我们治疗生长中的儿童或青少年踝关节外翻的首选方法。使用钢板骨骺阻滞术是安全的，耐受性良好，可轻松与其他治疗方法联合使用，且矫正率与经内踝螺钉方法相当。
IV级，回顾性研究，无对照系列。
