Sabharwal Sanjeev, Sakamoto Sara M, Zhao Caixia
Department of Orthopedics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
J Pediatr Orthop. 2013 Jul-Aug;33(5):551-7. doi: 10.1097/BPO.0b013e318285c524.
Children with Blount disease are often obese and have muliplanar limb deformities including leg length discrepancy. Surgical options for these skeletally immature patients include guided growth and realignment osteotomy. Suboptimal outcomes such as persistent valgus overcorrection after proximal tibial osteotomy in children with early-onset Blount disease and undercorrection after guided growth treatment among adolescents with late-onset Blount disease can occur. Although obesity has been associated with precocious puberty, whether children with Blount disease have advanced skeletal maturity has not been previously investigated. We hypothesized that compared to their peers, children with Blount disease will have advanced skeletal (bone) age.
The relationship between skeletal and chronologic age was compared between 33 patients with Blount disease (12 early-onset, 21 late-onset) and 33 age-matched and sex-matched controls. The influence of variables such as the age of onset of Blount disease and patient's chronologic age on the discrepancy between skeletal and chronologic age was also evaluated.
The mean body mass index was 39 kg/m2 in the Blount disease group and 23 kg/m2 in the control subjects (P<0.0001). Compared to their chronologic age, the bone age was advanced 16 months in Blount disease group (95% confidence interval, 10-22 mo) and 5 months in the control group (95% confidence interval, -1-10; P=0.003). On the basis of subgroup analysis, the bone age was advanced 26 months in early-onset and 10 months in late-onset Blount disease (P=0.01). The discrepancy between bone age and chronologic age decreased as chronologic age increased in both the control (r=-0.36, P=0.04) and Blount disease groups (r=-0.58, P=0.0004).
Compared to their peers, children with Blount disease have advanced skeletal maturity. The difference between bone age and chronologic age decreases with growth. Since advanced skeletal maturity can impact the strategy for surgical realignment and magnitude of planned (over)correction of lower limb deformity, preoperative assessment of bone age should be considered when managing children with Blount disease.
Level III.
患有布朗特病的儿童往往肥胖，且存在包括腿长差异在内的多平面肢体畸形。对于这些骨骼未成熟的患者，手术选择包括引导生长和截骨矫形。可能会出现一些不理想的结果，如早发型布朗特病患儿胫骨近端截骨术后持续外翻过度矫正，以及晚发型布朗特病青少年引导生长治疗后矫正不足。虽然肥胖与性早熟有关，但此前尚未研究过患有布朗特病的儿童骨骼成熟是否提前。我们假设，与同龄人相比，患有布朗特病的儿童骨骼（骨）龄会提前。
比较了33例布朗特病患者（12例早发型，21例晚发型）与33例年龄和性别匹配的对照者的骨骼年龄与实际年龄之间的关系。还评估了布朗特病发病年龄和患者实际年龄等变量对骨骼年龄与实际年龄差异的影响。
布朗特病组的平均体重指数为39kg/m²，对照组为23kg/m²（P<0.0001）。与实际年龄相比，布朗特病组的骨龄提前了16个月（95%置信区间，10 - 22个月），对照组提前了5个月（95%置信区间，-1 - 10；P = 0.003）。根据亚组分析，早发型布朗特病的骨龄提前26个月，晚发型提前10个月（P = 0.01）。在对照组（r = -0.36，P = 0.04）和布朗特病组（r = -0.58，P = 0.0004）中，骨龄与实际年龄的差异均随着实际年龄的增加而减小。
与同龄人相比，患有布朗特病的儿童骨骼成熟提前。骨龄与实际年龄的差异随着生长而减小。由于骨骼成熟提前会影响手术矫形策略以及下肢畸形计划（过度）矫正的程度，因此在治疗患有布朗特病的儿童时，应考虑术前评估骨龄。
三级。
