在患有多发性遗传性骨软骨瘤的患者中，采用张力带原理通过半骨骺阻滞术矫正踝外翻。
Correction of ankle valgus by hemiepiphysiodesis using the tension band principle in patients with multiple hereditary exostosis.
作者信息
van Oosterbos M, van der Zwan A L, van der Woude H J, Ham S J
机构信息
Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.
Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
出版信息
J Child Orthop. 2016 Jun;10(3):267-73. doi: 10.1007/s11832-016-0742-8. Epub 2016 May 27.
BACKGROUND
Ankle valgus is a common deformity in patients with multiple hereditary exostoses (MHE) and a potential risk factor for early degenerative arthritis. In children, medial hemiepiphysiodesis of the distal tibia is a relatively simple surgical technique used to correct this deformity. We present here the first results of applying this procedure using the eight-Plate guided growth system (eight-Plate) for growth guidance.
METHODS
Between 2006 and 2011 we performed hemiepiphysiodesis of the distal medial tibia in 30 ankles of 18 children with MHE using the eight-Plate. Weight-bearing total leg radiographs were obtained preoperatively, during follow-up and at the time of implant removal or when the distal tibial physis had closed. The lateral distal tibia angle (LDTA) was measured and fibular shortening assessed using the Malhotra classification. To evaluate the effect of hemiepiphysiodesis, we correlated the LDTA with age.
RESULTS
The mean age at time of surgery was 12.6 (range 9.5-15.0) years, and the mean preoperative LDTA was 76.9° (range 68.5°-83.5°). During follow-up, the implant was removed in 12 extremities and the physis had closed in 18 extremities. The mean LDTA at the time of implant removal or at closure of the physis was 83.6° (range 76.5°-90.0°). Mean correction of LDTA was 6.9° after a mean follow-up period of 22 (range 3-43) months. During follow-up, no changes in the Malhotra classification were found in any of the patients. Correction of the valgus deformity of the ankle was significantly correlated (r = -0.506) (p = 0.004) with age in all patients.
CONCLUSION
Temporary medial hemiepiphyseodesis of the distal tibia seems to be an effective strategy for correcting ankle valgus in children with MHE. Timing of the intervention is, however, of importance. Hemiepiphyseodesis alone has no effect on the Malhotra classification.
LEVEL OF EVIDENCE
IV, retrospective review.
背景
踝关节外翻是多发性遗传性骨软骨瘤（MHE）患者的常见畸形，也是早期退行性关节炎的潜在危险因素。对于儿童患者，胫骨远端内侧半骨骺阻滞术是一种相对简单的用于矫正这种畸形的手术技术。我们在此展示了使用八钢板引导生长系统（八钢板）进行生长引导应用该手术的初步结果。
方法
2006年至2011年期间，我们使用八钢板对18例患有MHE的儿童的30个踝关节进行了胫骨远端内侧半骨骺阻滞术。术前、随访期间以及取出植入物时或胫骨远端骨骺闭合时均拍摄负重全腿X线片。测量胫骨远端外侧角（LDTA），并使用Malhotra分类法评估腓骨短缩情况。为了评估半骨骺阻滞术的效果，我们将LDTA与年龄进行了相关性分析。
结果
手术时的平均年龄为12.6岁（范围9.5 - 15.0岁），术前平均LDTA为76.9°（范围68.5° - 83.5°）。随访期间，12个肢体取出了植入物，18个肢体的骨骺已闭合。取出植入物时或骨骺闭合时的平均LDTA为83.6°（范围76.5° - 90.0°）。平均随访22个月（范围3 - 43个月）后，LDTA的平均矫正角度为6.9°。随访期间，所有患者的Malhotra分类均未发生变化。在所有患者中，踝关节外翻畸形的矫正与年龄显著相关（r = -0.506）（p = 0.004）。
结论
胫骨远端临时内侧半骨骺阻滞术似乎是矫正患有MHE儿童踝关节外翻的有效策略。然而，干预时机很重要。单纯半骨骺阻滞术对Malhotra分类没有影响。
证据级别
IV，回顾性研究。
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