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使用八钢板系统矫正冠状畸形的生长调节——系统评价

Growth modulation for coronal deformity correction by using Eight Plates-Systematic review.

作者信息

Kumar Sanjay, Sonanis S V

机构信息

Department of Orthopaedics, United Lincolnshire Hospitals NHS Trust, Greetwell Rd, Lincoln LN2 5QY, United Kingdom.

Department of Orthopaedics, Hywel Dda University Health Board, Caradoc Road, Aberystwyth SY23 1ER, United Kingdom.

出版信息

J Orthop. 2018 Feb 2;15(1):168-172. doi: 10.1016/j.jor.2018.01.022. eCollection 2018 Mar.

Abstract

INTRODUCTION

Coronal deformities are commonly encountered in paediatric orthopaedics and surgical treatment is indicated for severe deformities causing pain, function and cosmetic problems. In a growing bone, major surgical intervention like osteotomy with internal or external fixation can be avoided by growth modulation (hemiepiphysiodesis) using 8-plates. Our aim is to review the published literature on the use of 8-plates for deformity correction.

METHODS

We conducted a systematic review on 8-plate growth modulation for coronal deformity correction. We carried out detailed literature search on PubMed, Google Scholar, EMBASE, and Cochrane databases. We analysed selected studies for patient demographics, rate of deformity correction, clinical outcome and complications.

RESULTS

We identified seven studies using 8-plate for deformity correction involving 215 patients (350 Limbs). The mean age was 9.5 years (2-16 years M/F Ratio 1.1:1); underlying aetiology was Idiopathic in 33% and Pathological 67% cases. The deformities were successfully corrected in 196/215 patients (91.2%) and partial/no correction in 19/215 patients (8.8%). The mean time to correction was 15.3 Months (10.3-25) and follows up of 18.9 months (12.4-24). The deformity corrected at 1.28 °/month (0.93-1.53), lateral distal femoral angle changed at 0.87°/month (0.65-1.0) and medial proximal tibial angle changed at 0.72 (0.5-1). Complications were reported in 12/215 patients (5.6%) including hardware failure in 5, overcorrection/leg length difference in 5, infection 1 and stiffness 1. The rebound was reported in 8 patients (3.7%).

CONCLUSION

Growth modulation with 8-plates has high efficacy and low complications for deformity correction; and has been used widely across all paediatric age groups and aetiology. The literature is mostly retrospective and heterogeneous to develop age and aetiology specific recommendations.

摘要

引言

冠状面畸形在小儿骨科中较为常见,对于导致疼痛、功能和美观问题的严重畸形,需进行手术治疗。在生长中的骨骼中,使用8字钢板进行生长调控(半骨骺阻滞术)可避免诸如截骨术加内固定或外固定等重大手术干预。我们的目的是回顾已发表的关于使用8字钢板矫正畸形的文献。

方法

我们对使用8字钢板进行生长调控以矫正冠状面畸形进行了系统评价。我们在PubMed、谷歌学术、EMBASE和Cochrane数据库中进行了详细的文献检索。我们分析了所选研究的患者人口统计学、畸形矫正率、临床结果和并发症。

结果

我们确定了7项使用8字钢板矫正畸形的研究,涉及215例患者(350条肢体)。平均年龄为9.5岁(2 - 16岁,男/女比例为1.1:1);33%的病例病因是特发性的,67%是病理性的。196/215例患者(91.2%)的畸形得到成功矫正,19/215例患者(8.8%)部分矫正或未矫正。平均矫正时间为15.3个月(10.3 - 25个月);随访时间为18.9个月(12.4 - 24个月)。畸形矫正速度为每月1.28°(0.93 - 1.53°),股骨远端外侧角变化速度为每月0.87°(0.65 - 1.0°),胫骨近端内侧角变化速度为每月0.72°(0.5 - 1°)。12/215例患者(5.6%)报告有并发症,包括5例内固定失败、5例过度矫正/腿长差异、1例感染和1例僵硬。8例患者(3.7%)报告有反弹。

结论

使用8字钢板进行生长调控矫正畸形具有高效性和低并发症发生率;已广泛应用于所有小儿年龄组和各种病因。文献大多为回顾性研究,且因年龄和病因不同而存在异质性,难以制定针对性的建议。

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