预测小儿下肢畸形生长调节中的晚期随访并了解其后果

Predicting Late Follow-up and Understanding Its Consequences in Growth Modulation for Pediatric Lower Limb Deformities.

作者信息

Lawing Cheryl, Margalit Adam, Ukwuani Gift, Sponseller Paul D

机构信息

Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.

出版信息

J Pediatr Orthop. 2019 Jul;39(6):295-301. doi: 10.1097/BPO.0000000000000951.

DOI:10.1097/BPO.0000000000000951

PMID:31169749

Abstract

BACKGROUND

Growth modulation with implants facilitates correction of angular deformities and limb-length discrepancies (LLDs) in children. Close follow-up is necessary when using growth modulation to prevent overcorrection. We examined factors associated with late follow-up and overcorrection rates in patients with late versus timely follow-up.

METHODS

This was a retrospective review of growth modulation procedures in children at 1 institution from 2000 through 2014. Procedures were assigned to the following categories on the basis of deformity: ankle valgus, genu valgum, genu varum, knee flexion contractures, and LLDs. Radiographic and clinical parameters were assessed. Late follow-up was defined as delaying a recommended appointment by ≥6 months. Loss to follow-up was defined as failure to return for a recommended postoperative appointment. Associations were evaluated using the following tests: χ, Fisher exact, analysis of variance, Mann-Whitney U, and logistic regression. Statistical significance was set at P<0.05.

RESULTS

Of the 112 patients, there were 41 cases of genu valgum, 23 of ankle valgus, 18 each of genu varum and LLD, and 12 of knee flexion contractures. Twenty-two patients had late follow-up. Another 22 patients were lost to follow-up with retained implants. Patients with late follow-up had significantly higher odds of experiencing overcorrection deformities versus patients with timely follow-up (odds ratio, 19.2; 95% confidence interval, 5.2-71.4; P<0.005). The only deformity for which there was a significant difference in final alignment between patients with timely versus late follow-up was genu valgum (P<0.005). Late follow-up was associated with having a primary language other than English (P=0.05) and being obese/overweight (P=0.004).

CONCLUSIONS

Late follow-up and loss to follow-up were common, occurring in 39% of patients combined. Late follow-up was associated with overcorrection in guided-growth procedures, as were overweight/obesity and primary language other than English.

LEVEL OF EVIDENCE

Level IV-retrospective case series.

摘要

背景

使用植入物进行生长调节有助于矫正儿童的角状畸形和肢体长度差异（LLD）。在使用生长调节时，密切随访对于防止过度矫正很有必要。我们研究了晚期随访患者与及时随访患者中与晚期随访和过度矫正率相关的因素。

方法

这是一项对2000年至2014年期间1家机构的儿童生长调节手术的回顾性研究。根据畸形情况将手术分为以下几类：踝外翻、膝外翻、膝内翻、膝关节屈曲挛缩和LLD。评估了影像学和临床参数。晚期随访定义为将推荐的预约推迟≥6个月。失访定义为未返回进行推荐的术后预约。使用以下检验评估相关性：χ检验、Fisher精确检验、方差分析、Mann-Whitney U检验和逻辑回归。统计学显著性设定为P<0.05。

结果

112例患者中，膝外翻41例，踝外翻23例，膝内翻和LLD各18例，膝关节屈曲挛缩12例。22例患者进行了晚期随访。另有22例患者失访，植入物仍留存。与及时随访的患者相比，晚期随访的患者出现过度矫正畸形的几率显著更高（优势比，19.2；95%置信区间，5.2 - 71.4；P<0.005）。及时随访与晚期随访的患者在最终对线方面存在显著差异的唯一畸形是膝外翻（P<0.005）。晚期随访与非英语母语（P = 0.05）和肥胖/超重（P = 0.004）有关。