Pesenti S, Iobst C A, Launay F
Orthopédie pédiatrique, hôpital d'enfants de la Timone, Aix-Marseille université, 264, rue Saint-Pierre, 13005 Marseille, France.
Nationwide Children's Hospital, 700 Children's Dr., 43205 Columbus, OH, USA.
Orthop Traumatol Surg Res. 2017 Sep;103(5):761-764. doi: 10.1016/j.otsr.2017.03.015. Epub 2017 Apr 17.
Tibial deformities are common in paediatric orthopaedic practice. Correcting multiplanar tibial deformities associated with lower limb length discrepancy can be challenging. Hexapod external fixation with gradual correction has been proven effective in this situation.
To assess clinical and radiological outcomes of gradual tibial deformity correction using the external fixator TL-HEX™ (Orthofix) in children.
TL-HEX™ is effective in correcting tibial deformities in children.
This multicentre retrospective study collected data from the medical files of 26 patients with 31 tibial deformities treated by gradual correction using TL-HEX™. The tibial deformities were due to congenital defects in 11 (35%) cases, Blount's disease in 9 (29%) cases, pseudo-achondroplasia in 4 (13%) cases, and other causes in 7 (23%) cases. Mean age at surgery was 11.9 years. In each patient, antero-posterior long leg radiographs obtained pre-operatively and at last follow-up were used to measure parameters including the mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), and leg length discrepancy (LLD).
The mean healing index was 39.3 days/cm (range, 32-58 days/cm). The overall complication rate was 61%, with 11 unplanned visits. Superficial pin tract infection was the most common complication. Significant decreases between the pre-operative and post-operative assessments occurred in mean MAD (from 32.1mm to 10.2mm, P<0.001) and mean LLD (from 36.8mm to 9.1mm, P<0.001). Patients who underwent proximal tibial osteotomy had a significant improvement in MPTA, from 80.6° to 88.5° (P=0.006).
This is the first clinical study specifically designed to assess outcomes of TL-HEX™ limb lengthening and deformity correction. MAD, MPTA, and LLD were significantly improved at last follow-up. MAD was greater than 10mm at last follow-up in only 11patients. The complication rate was similar to those reported with other external fixators. TL-HEX™ is effective in the management of tibial deformities in children.
IV (retrospective study).
胫骨畸形在小儿骨科临床实践中很常见。矫正与下肢长度差异相关的多平面胫骨畸形具有挑战性。在这种情况下，逐步矫正的六足外固定已被证明是有效的。
评估使用TL-HEX™（奥索）外固定器逐步矫正儿童胫骨畸形的临床和放射学结果。
TL-HEX™在矫正儿童胫骨畸形方面有效。
这项多中心回顾性研究收集了26例患者31处胫骨畸形的病历资料，这些患者均采用TL-HEX™进行逐步矫正治疗。胫骨畸形的病因包括11例（35%）先天性缺陷、9例（29%）布朗特病、4例（13%）假性软骨发育不全以及7例（23%）其他原因。手术时的平均年龄为11.9岁。对每位患者术前和末次随访时的前后位长腿X线片进行测量，参数包括机械轴偏移（MAD）、胫骨近端内侧角（MPTA）和下肢长度差异（LLD）。
平均愈合指数为39.3天/厘米（范围为32 - 58天/厘米）。总体并发症发生率为61%，有11次非计划就诊。浅表针道感染是最常见的并发症。术前和术后评估之间，平均MAD（从32.1毫米降至10.2毫米，P<0.001）和平均LLD（从36.8毫米降至9.1毫米，P<0.001）有显著下降。接受胫骨近端截骨术的患者MPTA有显著改善，从80.6°提高到88.5°（P = 0.006）。
这是第一项专门设计用于评估TL-HEX™肢体延长和畸形矫正结果的临床研究。末次随访时，MAD、MPTA和LLD均有显著改善。末次随访时，仅11例患者的MAD大于10毫米。并发症发生率与其他外固定器报道的相似。TL-HEX™在儿童胫骨畸形的治疗中有效。
IV（回顾性研究）。
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