Orthopedic Department, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva 49100, Israel.
J Bone Joint Surg Am. 2013 Nov 20;95(22):2022-7. doi: 10.2106/JBJS.L.00819.
Guided growth is most commonly utilized about the knee and ankle for the correction of coronal-plane deformities by the use of plates positioned perpendicular to the physis. Sagittal-plane deformity correction has been described as well. The purpose of our study was to examine the ability to affect axial-rotational growth. Our hypothesis was that placement of plates in an oblique orientation relative to the physis can induce rotational growth deformity.
Our hypothesis was tested with use of a mathematical model and a bone model and subsequently in a rabbit model. Thirteen six-week-old rabbits underwent a rotational guided growth procedure involving the distal aspect of the right femur, with a sham procedure performed on the left side. Two plates were positioned in an oblique orientation relative to the physis, medially and laterally, to guide either internal or external rotational growth. After the rabbits were killed six weeks after the surgery, the femoral rotational profile was assessed by computed tomography scans of the dissected femora and the growth plates were examined histologically.
A significant effect on the rotational profile was found in the treated femora. When the plates were positioned to guide external rotation, the rotational profile was significantly greater in the treated femora (29.0° compared with 11.3° in the sham femora; p = 0.008). There was a positive linear correlation between the right-left difference in rotational profile and the change in inter-plate angle (R2 = 0.72, p = 0.001). Every 1° of inter-plate angle change induced 0.367° of rotational profile difference (p = 0.001). Histologically, a swirling effect of the physeal cell columns was seen in the treated femora.
Guided growth using plates was demonstrated to alter axial-rotational growth in a predictable fashion in a rabbit model.
Guided growth using plates may be effective for correction of rotational and multiplanar deformities.
引导生长最常用于膝关节和踝关节，通过使用垂直于骺板的钢板来纠正冠状面畸形。也描述了矢状面畸形矫正。我们的研究目的是检查影响轴向旋转生长的能力。我们的假设是，相对于骺板以倾斜的方式放置钢板可以诱导旋转生长畸形。
我们使用数学模型和骨模型以及随后的兔模型来检验我们的假设。13 只 6 周龄的兔子接受了右股骨远端的旋转引导生长手术，左侧进行了假手术。两块钢板相对于骺板以倾斜的方式放置在内侧和外侧，以引导内旋或外旋生长。手术后 6 周处死兔子，通过对解剖股骨的 CT 扫描评估股骨的旋转轮廓，并对生长板进行组织学检查。
在治疗的股骨中发现了旋转轮廓的显著影响。当钢板被定位以引导外旋时，治疗股骨的旋转轮廓显著增大（29.0°与假股骨的 11.3°相比；p = 0.008）。在旋转轮廓的左右差异与板间角度变化之间存在正线性相关（R2 = 0.72，p = 0.001）。板间角度每变化 1°，旋转轮廓差异为 0.367°（p = 0.001）。组织学上，在治疗的股骨中观察到骺板细胞柱的旋转效应。
在兔模型中，使用钢板的引导生长被证明可以以可预测的方式改变轴向旋转生长。
使用钢板的引导生长可能有效纠正旋转和多平面畸形。
