Pendleton Albert Martin, Stevens Peter Morris, Hung Man
Department of Sports Medicine (AMP), Children’s Hospital Boston, Boston, Massachusetts 02445 , USA.
Orthopedics. 2013 May;36(5):e575-80. doi: 10.3928/01477447-20130426-18.
The purpose of this study was to evaluate the effectiveness and complication rate of guided growth for the treatment of patients with a moderate leg-length discrepancy. The authors retrospectively reviewed all patients treated with guided growth for a moderate leg-length discrepancy at their institution between October 2004 and December 2010. Thirty-four patients met the inclusion criteria from an initial cohort of 105 patients. All patients were followed until screw removal or maturity occurred. Nine patients had a developmental leg-length discrepancy, and 25 had a congenital leg-length discrepancy. Average age was 12.6 years (range, 7-16 years). Average leg-length discrepancies, as measured on standing long-leg radiographs from the top of the pelvis, the top of the femoral heads, and the center of the ankle to the top of the femoral heads, were 22, 19, and 17 mm, respectively. Average discrepancies at screw removal or maturity were 13, 10, and 11 mm, respectively. Twenty of 33 patients had a leg-length discrepancy of less than 1 cm at maturity or screw removal. The leg-length discrepancy change in patients who underwent guided growth of the tibia was minimal. Leg-length discrepancies in patients who underwent guided growth of the femur or both the femur and the tibia changed by an average of 10 mm. One patient had a mechanical axis change greater than 1 zone, and 1 patient required treatment for angular deformity after being treated for a leg-length discrepancy. Guided growth is a safe and effective technique for treating moderate leg-length discrepancies.
本研究的目的是评估引导生长术治疗中度下肢长度不等患者的有效性及并发症发生率。作者回顾性分析了2004年10月至2010年12月期间在其机构接受引导生长术治疗中度下肢长度不等的所有患者。105例初始队列患者中，34例符合纳入标准。所有患者均随访至螺钉取出或骨骼成熟。9例患者为发育性下肢长度不等，25例为先天性下肢长度不等。平均年龄为12.6岁（范围7 - 16岁）。站立位长腿X线片测量的平均下肢长度不等，从骨盆顶部、股骨头顶部以及踝关节中心至股骨头顶部，分别为22 mm、19 mm和17 mm。螺钉取出或骨骼成熟时的平均下肢长度不等分别为13 mm、10 mm和11 mm。33例患者中有20例在骨骼成熟或螺钉取出时下肢长度不等小于1 cm。接受胫骨引导生长术的患者下肢长度不等变化极小。接受股骨引导生长术或股骨及胫骨引导生长术的患者下肢长度不等平均变化10 mm。1例患者机械轴变化大于1个区域，1例患者在接受下肢长度不等治疗后因角状畸形需要治疗。引导生长术是治疗中度下肢长度不等的一种安全有效的技术。
