干骺端内侧倾斜度预测 Blount 病复发。

Medial Metaphyseal Slope as a Predictor of Recurrence in Blount Disease.

机构信息

Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Orthop Surg. 2019 Jun;11(3):474-480. doi: 10.1111/os.12491.

DOI:10.1111/os.12491

PMID:31243919

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6595116/

Abstract

OBJECTIVE

This study was aimed to find the radiographic parameter predicting recurrence of stage 2 Blount's disease.

METHOD

We retrospectively reviewed radiographs of 82 legs from 49 patients diagnosed with stage 2 Blount's disease by Langenskiöld classification who had failed brace treatment and underwent valgus osteotomy between 1998 to 2016. Age ranged from 26 to 47 months. The metaphyseal-diaphyseal angle was measured preoperatively. The medial metaphyseal slope of the proximal tibia and femorotibial angle were measured preoperatively and 3, 6, 12, and 24 months postoperatively in both non-recurrence (group 1) and recurrence (group 2) group. The receiver operating characteristic curve calculated using MedCalc software was used to determine the medial metaphyseal slope predicting risk for recurrence. Statistical analysis was performed using SPSS software.

RESULTS

The mean follow-up time was 4.83 ± 0.38 years. The mean age was 34.57 ± 5.76 in group 1 and 33.2 ± 1.48 in group 2 (P = 0.258). The mean preoperative metaphyseal slope was 62.39° ± 9.75° in group 1 and 73.22° ± 6.59° in group 2 (P = 0.02). The mean preoperative femorotibial angle (FTA) was -14.31° ± 8.25° in group 1 and -18.89° ± 7.74° in group 2 (P = 0.1). The mean preoperative metaphyseal diaphyseal angle (MDA) was 14.75° ± 4.21° in group 1 and 20.11° ±5.16° in group 2 (P = 0.001). Demographic data including age, gender, weight, height, and body mass index showed no statistically significant difference between both groups. Out of 82 legs, 9 (10.97%) had recurrence. Preoperatively, the metaphyseal-diaphyseal angle showed statistical significance between both groups. The medial metaphyseal slope showed statistically significant difference between group 1 and group 2 at 3, 6, 12, and 24 months postoperatively. The receiver operating characteristic curve showed that a medial metaphyseal slope more than 70° at 12 months (sensitivity 88.89% and specificity 69.86%) and more than 62° at 24 months postoperatively (sensitivity 100%, specificity 52.3%) was a predictor for recurrence of stage 2 Blount's disease.

CONCLUSION

Medial metaphyseal slope more than 62° over the 24-month follow-up was associated with recurrence of varus deformity.

摘要

目的

本研究旨在寻找预测 2 期 Blount 病复发的影像学参数。

方法

我们回顾性分析了 1998 年至 2016 年间因 Langenskiöld 分类的 2 期 Blount 病而接受支具治疗失败并接受外翻截骨术的 49 例患者 82 条腿的影像学资料。年龄为 26 至 47 个月。术前测量干骺端-骨干角。术前及术后 3、6、12 和 24 个月分别测量胫骨近端干骺端斜率和股胫角。使用 MedCalc 软件计算受试者工作特征曲线以确定预测复发风险的内侧干骺端斜率。使用 SPSS 软件进行统计分析。

结果

平均随访时间为 4.83 ± 0.38 年。第 1 组的平均年龄为 34.57 ± 5.76 岁，第 2 组为 33.2 ± 1.48 岁（P = 0.258）。第 1 组术前干骺端斜率为 62.39° ± 9.75°，第 2 组为 73.22° ± 6.59°（P = 0.02）。第 1 组术前股胫角（FTA）为-14.31° ± 8.25°，第 2 组为-18.89° ± 7.74°（P = 0.1）。第 1 组术前干骺端骨干角（MDA）为 14.75° ± 4.21°，第 2 组为 20.11° ±5.16°（P = 0.001）。两组间的年龄、性别、体重、身高和体重指数等人口统计学数据无统计学差异。82 条腿中，9 条（10.97%）发生复发。术前，两组间的干骺端骨干角有统计学意义。术后 3、6、12 和 24 个月，第 1 组和第 2 组的胫骨近端内侧干骺端斜率有统计学差异。受试者工作特征曲线显示，术后 12 个月内侧干骺端斜率大于 70°（灵敏度 88.89%，特异性 69.86%）和术后 24 个月大于 62°（灵敏度 100%，特异性 52.3%）是 2 期 Blount 病复发的预测指标。