Troy M, Shore B, Miller P, Mahan S, Hedequist D, Heyworth B, Kasser J, Spencer S, Glotzbecker M
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
J Child Orthop. 2018 Oct 1;12(5):509-514. doi: 10.1302/1863-2548.12.180030.
To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates.
A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved.
A total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001).
Effectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED.
III.
比较两种常见的骺板阻滞手术技术：钻孔/刮除骺板阻滞术（PDED）和交叉螺钉骺板阻滞术（PETS）。假设这两种技术疗效相似，但在住院时间（LOS）、恢复活动时间和并发症发生率方面存在差异。
对年龄小于18岁、因下肢长度差异（LLD）2厘米至6厘米而需要进行骺板阻滞且至少随访两年的儿童和青少年进行回顾性研究。比较各治疗组的手术年龄、性别、骺板阻滞位置、手术侧、手术时间、住院时间和内固定取出等特征。术前及最近一次随访时测定LLD、预期剩余生长（EGR）和骨龄。计算矫正率（EGR变化）及95%置信区间（CI），以评估下肢长度矫正是否实现。
共有115例患者接受了股骨（53%）、胫骨（24%）或两者联合（24%）的骺板阻滞术。队列中男性占47%，手术时平均年龄为12.6岁（7.7至17.7岁）。中位随访时间为3.7年（2.0至12.7年）。共有23例患者接受了PETS，92例患者接受了PDED。两个治疗组均实现了预期的LLD矫正。中位手术时间、并发症发生率或住院时间无显著差异。PETS组患者平均1.4个月（四分位间距（IQR）0.7至2.1）恢复活动，而PDED组患者平均2.4个月（IQR 1.7至3）恢复活动（p<0.001）。
螺钉骺板阻滞术和钻孔/刮除骺板阻滞术在实现预期矫正、住院时间和手术时间方面效果相似。接受PETS的患者比接受PDED的患者恢复至基线活动的速度更快。
III级。
