Boero Silvio, Michelis Maria Beatrice, Riganti Simone
Department of Pediatric Orthopedics, Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147 Genoa, Italy.
J Child Orthop. 2011 Jun;5(3):209-16. doi: 10.1007/s11832-011-0344-4. Epub 2011 May 12.
Angular deformities of the knee resulting from idiopathic, congenital, or acquired causes are commonly encountered in pediatric orthopedics. Whereas physiological deformities should be treated expectantly, the remaining often progress enough to warrant operative treatment, despite attempted bracing. Historical methods of surgical treatment (e.g., epiphysiodesis and stapling) have yielded to the increasingly popular method of reversible guided growth using the eight-Plate.
We studied 58 patients with knee angular deformities managed with eight-Plate guided growth. All etiologies except physiological deformities and those with very slow growth rate were included. Each patient was under appropriate medical management during the entire duration of treatment and after plate removal.
In the dysplasia/syndrome group, we noted complete correction in 22 patients (78.5%), partial correction in 5 (17.9%), and no correction in 1 patient (3.6%). All cases of idiopathic deformities resolved. Patients with osteochondral dysplasias and genetic syndromes underwent earlier intervention and slower correction than those with idiopathic genu varum or valgum. The time difference in reaching a neutral mechanical axis between the two groups (11 months in idiopathic versus 18 months in pathological physis) could be explained by a significant difference in growth speeds (P = 0.003).
Results indicate that early intervention is advisable for patients with osteochondral dysplasias/syndromes as subsequent correction takes longer. If rebound growth causing recurrent deformity occurs, guided growth can be safely repeated. Additionally, complications reported with other techniques such as hardware failure, physeal violation by the implant, premature physeal closure, and overcorrection were not reported while using the eight-Plate.
在小儿骨科中，特发性、先天性或后天性原因导致的膝关节角畸形较为常见。生理性畸形应予以观察等待，而其余畸形尽管尝试使用支具治疗，但仍常常进展到需要手术治疗的程度。历史上的手术治疗方法（如骨骺阻滞术和骨钉固定术）已逐渐被使用八字钢板的可逆性引导生长这一越来越流行的方法所取代。
我们研究了58例采用八字钢板引导生长治疗膝关节角畸形的患者。纳入了除生理性畸形和生长速度非常缓慢的畸形之外的所有病因。每位患者在整个治疗期间及取出钢板后均接受了适当的医疗管理。
在发育异常/综合征组中，我们发现22例患者（78.5%）完全矫正，5例患者（17.9%）部分矫正，1例患者（3.6%）未矫正。所有特发性畸形病例均得到解决。与特发性膝内翻或膝外翻患者相比，骨软骨发育异常和遗传综合征患者接受干预更早，矫正速度更慢。两组达到中立机械轴的时间差异（特发性组为11个月，病理性骨骺组为18个月）可以用生长速度的显著差异来解释（P = 0.003）。
结果表明，对于骨软骨发育异常/综合征患者，早期干预是可取的，因为后续矫正需要更长时间。如果出现导致复发畸形的反弹生长，可以安全地重复进行引导生长。此外，使用八字钢板时未报告其他技术所报道的并发症，如内固定失败、植入物侵犯骨骺、骨骺过早闭合和过度矫正。
