Song Mi Hyun, Choi Eun-Seok, Park Moon Seok, Yoo Won Joon, Chung Chin Youb, Choi In Ho, Cho Tae-Joon
*Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju †Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul ‡Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
J Pediatr Orthop. 2015 Jan;35(1):89-93. doi: 10.1097/BPO.0000000000000214.
Percutaneous epiphysiodesis using transphyseal screws (PETS) has been used to manage leg length discrepancy (LLD) in growing children. The purposes of this study were to analyze effects of PETS on LLD, its associated complications, to determine optimal operation timing, and find ways of preventing complications.
The data of 59 patients obtained up to screw removal or at skeletal maturity were retrospectively analyzed. Retrospective growth calculations were done using multiplier method. The efficacy of LLD correction was calculated, and the predicted segment length with the index operation was compared with the final measured length and final LLD was measured. The screw insertion angle in 3-dimension was calculated, and it was correlated with the efficacy. Complications associated with screw design and the techniques used were analyzed.
The LLD correction efficacy averaged 75.5% (5.0 to 114.0) at the distal femur and 78.9% (11.0 to 111.0) at the proximal tibia. However, mean final LLD was 3.0 mm (range, -10.0 to 16.7 mm), presumably because operations were performed on average 1.3 years earlier than estimated by growth calculation. Three-dimensional screw insertion angle was positively correlated with LLD correction efficacy. Complications were closely related to the screw design and the implantation techniques.
PETS provides a minimally invasive and effective means of LLD correction. In view of its delayed effect, we recommend that PETS be performed at least 1 year earlier than estimated optimal epiphysiodesis timing. The careful selection of screw design and length and accurate screw placement are the keys to successful results.
Level IV prognostic studies.
使用经骨骺螺钉的经皮骨骺阻滞术（PETS）已被用于治疗生长发育期儿童的下肢长度不等（LLD）。本研究的目的是分析PETS对LLD的影响、其相关并发症，确定最佳手术时机，并找到预防并发症的方法。
回顾性分析了59例患者直至螺钉取出或骨骼成熟时的数据。采用乘数法进行回顾性生长计算。计算LLD矫正的疗效，将指数手术时预测的节段长度与最终测量长度进行比较，并测量最终的LLD。计算三维螺钉置入角度，并将其与疗效相关联。分析与螺钉设计和所使用技术相关的并发症。
股骨远端的LLD矫正疗效平均为75.5%（5.0至114.0），胫骨近端为78.9%（11.0至111.0）。然而，最终平均LLD为3.0毫米（范围为-10.0至16.7毫米），推测是因为手术平均比生长计算估计的时间早1.3年进行。三维螺钉置入角度与LLD矫正疗效呈正相关。并发症与螺钉设计和植入技术密切相关。
PETS提供了一种微创且有效的LLD矫正方法。鉴于其延迟效应，我们建议PETS至少比估计的最佳骨骺阻滞时机提前1年进行。仔细选择螺钉设计和长度以及准确的螺钉置入是取得成功结果的关键。
IV级预后研究。
