Akpinar Evren, Ozyalvac Osman Nuri, Bayhan Ilhan Avni, Beng Kubilay, Kocabiyik Ahmet, Yagmurlu Mehmet Firat
Baltalimani Bone Diseases Education and Training Hospital, Department of Pediatric Orthopaedic Surgery, Istanbul, Turkey.
Sultanbeyli State Hospital, Istanbul, Turkey.
Indian J Orthop. 2019 Jul-Aug;53(4):548-553. doi: 10.4103/ortho.IJOrtho_166_18.
Greater trochanter apophysiodesis (GTA) is relatively minimal invasive technique for the treatment of trochanteric overgrowth. Various types of implants can be used in each procedure. The purpose of this study was to compare outcomes of three different types of implants that were used in treatment of trochanteric overgrowth in Legg-Calve-Perthes disease.
We retrospectively studied radiological results of three implants (screw, screw washer, and EP) on inhibiting trochanteric growth in 32 patients. Articulo-trochanteric and trochanter-trochanter distances (TTDs) were measured on radiographs. Embedding of implant evaluated on final radiographs.
The mean of age at the surgery was 10 ± 2.3 years, and the mean of follow up period was 50.0 ± 16.7 months. In all groups, articulo-trochanteric distance was decreased on final radiographs. In screw and screw washer group, increase of TTD was not statistically significant ( < 0.05). Twelve, one, and two implants were embedded, respectively, in screw, screw washer, and EP groups. Two patients in EP group had revision surgery due to loosening.
In this study group, GTA using screw and screw washer methods could slow down but did not restore trochanteric overgrowth. We suggest using washer to reduce embedding of the screw.
大转子骨骺固定术（GTA）是治疗转子过度生长的相对微创技术。每个手术过程中可使用各种类型的植入物。本研究的目的是比较用于治疗Legg-Calve-Perthes病转子过度生长的三种不同类型植入物的疗效。
我们回顾性研究了32例患者中三种植入物（螺钉、螺钉垫圈和EP）抑制转子生长的放射学结果。在X线片上测量关节转子和转子间距离（TTD）。在最终X线片上评估植入物的嵌入情况。
手术时的平均年龄为10±2.3岁，平均随访期为50.0±16.7个月。在所有组中，最终X线片上关节转子距离均减小。在螺钉和螺钉垫圈组中，TTD的增加无统计学意义（<0.05）。螺钉组、螺钉垫圈组和EP组分别有12个、1个和2个植入物嵌入。EP组有2例患者因松动进行了翻修手术。
在本研究组中，使用螺钉和螺钉垫圈方法的GTA可以减缓但不能恢复转子过度生长。我们建议使用垫圈以减少螺钉的嵌入。
