Kemppainen John W, Hood Kenneth A, Roocroft Joanna H, Schlechter John A, Edmonds Eric W
*Department of Orthopaedic Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI †Department of Orthopedic Surgery, Children's Hospital Orange County, Orange ‡Department of Orthopedic Surgery, Rady Children's Hospital and Health Center §Department of Orthopedic Surgery, University of California San Diego, San Diego, CA.
J Pediatr Orthop. 2016 Jul-Aug;36(5):516-20. doi: 10.1097/BPO.0000000000000487.
Extraperiosteal tension plates have become the predominant method for angular deformity correction in skeletally immature patients, with some surgeons using them in very young children with the intent of removing the implants once the correction is complete. The purpose of this study is to determine the incidence of incomplete follow-up and to assess the outcomes of children who were lost to follow-up with retained implants.
A quality initiative survey was performed at 2 institutions on children treated with extraperiosteal tension plates around the knee because of sentinel events that occurred at each institution. Compliance with follow-up was noted, and children with open perigenicular physes on latest radiograph with retained implants were identified with attempts to reestablish care. Subsequent review of those children was performed, including clinical results, radiographic results, and the need for second deformity surgery.
A total of 200 children treated with tension plates were identified (116 at institution #1, 84 at institution #2). The most common indication for surgery was genu valgum (54%), and the mean age at initial surgery was 11.7 years (range, 3.1 to 16.8 y). A high rate of retained implants with incomplete follow-up was identified at both institutions, where a total of 23 patients (12%) were lost with implants still in place. Only 7 of 23 patients returned for evaluation: 3 reached skeletal maturity with no complications, but 4 overcorrected creating the opposite angular deformity. Two of those children required osteotomies to remedy their overcorrection. Two additional patients were reachable, but failed to return for follow-up and the remaining patients were unreachable.
The incidence of incomplete follow-up was significant at both institutions (12% combined incidence). Of those who were found for follow-up, nearly one third required a surgery beyond simple implant removal. Incomplete follow-up among this cohort was identified as a significant quality of care issue, and an EMR system has been established to actively follow children receiving growth modulation surgery.
Level IV.
骨膜外张力板已成为骨骼未成熟患者矫正角状畸形的主要方法，一些外科医生在非常年幼的儿童中使用该方法，意图是在矫正完成后取出植入物。本研究的目的是确定随访不完整的发生率，并评估植入物保留但失访儿童的治疗结果。
在两家机构针对因各机构发生的哨兵事件而接受膝关节周围骨膜外张力板治疗的儿童进行了一项质量改进调查。记录随访依从性，通过最新X光片确定保留植入物且膝关节周围骨骺开放的儿童，并尝试重新建立护理。随后对这些儿童进行了复查，包括临床结果、影像学结果以及二次畸形手术的必要性。
共确定200例接受张力板治疗的儿童（机构1为116例，机构2为84例）。最常见的手术指征是膝外翻（54%），初次手术的平均年龄为11.7岁（范围3.1至16.8岁）。两家机构均发现保留植入物且随访不完整的发生率较高，共有23例患者（12%）植入物仍在位时失访。23例患者中只有7例返回接受评估：3例达到骨骼成熟且无并发症，但4例过度矫正导致出现相反的角状畸形。其中2名儿童需要进行截骨术来纠正过度矫正。另外2例患者能够联系上，但未返回接受随访，其余患者无法联系上。
两家机构随访不完整的发生率均较高（合并发生率为12%）。在那些被找到进行随访的患者中，近三分之一除了简单取出植入物外还需要进行手术。该队列中的随访不完整被确定为一个重要的护理质量问题，并且已经建立了一个电子病历系统来积极随访接受生长调节手术的儿童。
四级。
