Dodwell Emily R, Garner Matthew R, Bixby Elise, Luderowski Eva M, Green Daniel W, Blanco John S, Widmann Roger F
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033 USA.
HSS J. 2017 Oct;13(3):255-262. doi: 10.1007/s11420-017-9549-5. Epub 2017 Apr 3.
Percutaneous epiphysiodesis using transphyseal screws (PETS) has been associated with implant failure, implant prominence, angular deformities, and delayed growth inhibition.
QUESTIONS/PURPOSES: The aim of this study was to assess the complication rate and efficacy (defined as actual growth inhibition divided by expected growth inhibition) of PETS and to identify factors associated with improved efficacy.
Patients who underwent distal femoral and/or proximal tibial PETS between January 2007 and June 2014 were identified. Complications, efficacy, and final limb-length discrepancy (LLD) were calculated using multipliers and inhibition rates based on previous growth. Associations between efficacy and screw insertion angle (SIA), body mass index, and number of threads crossing the physis were calculated.
Eight-two patients (126 treated physes) were included. The mean pre-operative LLD was 27.7 mm (SD = 7.5). Following epiphysiodesis, 15 had temporary pain (18%), five had temporary effusion (6.1%), four had broken implants (4.9%), four developed mild angulation (4.9%), and three had failed epiphysiodesis requiring revision (3.7%). Thirty-one underwent screw removal ( = 31, 38%). Mean LLD at maturity was 17.3 mm (SD = 5.8 mm). Mean efficacy at the distal femur was 97% (SD = 46%), at the proximal tibia was 108% (SD = 66%) and was 103% (SD = 57%) overall. Increased screw threads across the lateral proximal tibial physis (Spearman's correlation coefficient = 0.67; 95% CI = 0.40-0.94) and higher BMI (Spearman's correlation coefficient = 0.55; 95% CI = 0.34-0.77) were positively associated with increased efficacy.
The efficacy of PETS may be more favorable than previously reported. Only 3.7% had serious complications requiring revision epiphysiodesis, lower than previous reports. Attention to sufficient screw threads across the physis may be important in optimizing PETS results.
使用经骨骺螺钉的经皮骨骺阻滞术（PETS）与植入物失败、植入物突出、角状畸形及生长抑制延迟有关。
问题/目的：本研究的目的是评估PETS的并发症发生率和疗效（定义为实际生长抑制除以预期生长抑制），并确定与疗效改善相关的因素。
确定2007年1月至2014年6月期间接受股骨远端和/或胫骨近端PETS的患者。使用基于既往生长情况的乘数和抑制率计算并发症、疗效及最终肢体长度差异（LLD）。计算疗效与螺钉插入角度（SIA）、体重指数及穿过骨骺的螺纹数量之间的相关性。
纳入82例患者（126个治疗的骨骺）。术前平均LLD为27.7mm（标准差=7.5）。骨骺阻滞术后，15例有临时疼痛（18%），5例有临时积液（6.1%），4例植入物断裂（4.9%），4例出现轻度成角（4.9%），3例骨骺阻滞失败需要翻修（3.7%）。31例进行了螺钉取出（n = 31，38%）。成熟时平均LLD为17.3mm（标准差=5.8mm）。股骨远端平均疗效为97%（标准差=46%），胫骨近端为108%（标准差=66%），总体为103%（标准差=57%）。胫骨近端外侧骨骺上增加的螺钉螺纹（斯皮尔曼相关系数=0.67；95%可信区间=0.40 - 0.94）和较高的体重指数（斯皮尔曼相关系数=0.55；95%可信区间=0.34 - 0.77）与疗效增加呈正相关。
PETS的疗效可能比先前报道更理想。只有3.7%的患者出现需要翻修骨骺阻滞术的严重并发症，低于先前报道。在优化PETS结果时，注意骨骺上有足够的螺钉螺纹可能很重要。
