Rupprecht Martin, Spiro Alexander S, Schlickewei Carsten, Breyer Sandra, Ridderbusch Karsten, Stücker Ralf
*Department of Pediatric Orthopaedics, The Altona Children's Hospital Departments of †Orthopaedics ‡Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Pediatr Orthop. 2015 Jan;35(1):94-9. doi: 10.1097/BPO.0000000000000224.
Temporary screw epiphysiodesis of the distal tibia is employed to correct ankle valgus deformity in patients with a wide spectrum of underlying etiologies. For patients with hereditary multiple exostosis it is unclear whether a rebound phenomenon may play a role after screw removal (SR) and successful management of ankle valgus deformity.
From January 2002 to July 2013, 10 boys and 2 girls with HME and an ankle valgus deformity were included in this study. To be included the following criteria had to be met: patients had to have undergone temporary medial malleolar screw epiphysiodesis, SR at the time of skeletal maturity or correction of the deformity, a follow-up (FU) at least 6 months after SR, and consistent radiographs obtained preoperatively at the time of SR as well at FU. The average age at the time of operation was 11.6±1.5 years (range, 9.6 to 14.7 y). The tibiotalar tilt (TT) was analyzed preoperatively, at SR and at FU.
The average preoperative TT was 13.2±4.9 degrees. Twenty-four months (±10) after epiphysiodesis all screws were removed. At SR, the TT was normalized to 0.8±4.8 degrees (P<0.001), according to an average rate of correction of 0.63±0.28 degrees per month. Twenty-two months (±13) after SR, the TT increased up to 3.2±4.9 degrees (P<0.05), a rebound (>5 degrees) occurred in 43%, managed by repeated epiphysiodesis. No deep infections or implant complications occurred. No permanent damage of the physis was observed in any case.
Medial malleolar screw epiphysiodesis is a successful treatment for the correction of ankle valgus deformity in patients with HME. A rebound after SR in the growing child or adolescent occurs in almost 50% of patients with HME, which can easily be managed by repeated epiphysiodesis. Therefore, we do not recommend overcorrection into a slight varus deformity. Because of the varying correction and recurrence rates, close FUs are of paramount importance.
Level IV.
胫骨远端临时螺钉骺阻滞术用于矫正多种潜在病因患者的踝外翻畸形。对于遗传性多发性骨软骨瘤患者，在取出螺钉（SR）并成功矫正踝外翻畸形后，尚不清楚反弹现象是否会起作用。
2002年1月至2013年7月，本研究纳入了10名男孩和2名患有遗传性多发性骨软骨瘤且有踝外翻畸形的女孩。纳入需满足以下标准：患者必须接受过临时内踝螺钉骺阻滞术，在骨骼成熟时或畸形矫正时进行SR，SR后至少随访（FU）6个月，并且在SR时及FU时获得术前一致的X线片。手术时的平均年龄为11.6±1.5岁（范围9.6至14.7岁）。术前、SR时及FU时分析胫距倾斜（TT）。
术前平均TT为13.2±4.9度。骺阻滞术后24个月（±10）取出所有螺钉。在SR时，TT恢复正常至0.8±4.8度（P<0.001），平均每月矫正率为0.63±0.28度。SR后22个月（±13），TT增加至3.2±4.9度（P<0.05），43%出现反弹（>5度），通过重复骺阻滞术处理。未发生深部感染或植入物并发症。在任何情况下均未观察到骨骺的永久性损伤。
内踝螺钉骺阻滞术是矫正遗传性多发性骨软骨瘤患者踝外翻畸形的成功治疗方法。在生长中的儿童或青少年中，几乎50%的遗传性多发性骨软骨瘤患者在SR后会出现反弹，可通过重复骺阻滞术轻松处理。因此，我们不建议过度矫正至轻度内翻畸形。由于矫正和复发率不同，密切随访至关重要。
四级。
