Danino B, Rödl R, Herzenberg J E, Shabtai L, Grill F, Narayanan U, Segev E, Wientroub S
The Department of Pediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Child Orthop. 2019 Jun 1;13(3):318-323. doi: 10.1302/1863-2548.13.190033.
To evaluate the temporal and spatial sequence of events following temporal hemiepiphysiodesis in idiopathic knee varus/valgus.
This is a retrospective multicentre study on 372 physes in 206 patients. The average rate of correction (ROC) was calculated; univariate and multivariate analysis were performed.
In all, 92% of the femoral physes were followed for more than one year/reached skeletal maturity. Of those, 93% were corrected to a mechanical lateral distal femoral angle (mLDFA) of 85° to 89°; 2% did not, while 5% were over-corrected. A total of 92% of the tibial physes were followed for more than one year/reached skeletal maturity. Of those, 92% were corrected to a mechanical medial proximal tibial angle (mMPTA) of 85° to 89°; 2% did not, while 6% were over-corrected. Factors significantly influencing success and ROC were age, direction and magnitude of deformity. Femoral ROC was significantly faster than tibial ROC: 0.85° versus 0.78°/month, respectively (p = 0.05). Femoral valgus ROC was significantly faster than varus ROC: 0.90° versus 0.77°/month, respectively (p = 0.04). A constant was derived to calculate the amount of correction. Significant correlation was found between calculated and actual mLDFA in valgus deformity during the first year (r = 0.58 to 0.87, p < 0.01). Calculated mLDFA of varus deformity did not correlate with actual mLDFA. Significant correlation was found when calculating mMPTA correction in all deformities.
Femur corrects faster than tibia; valgus femoral deformities are corrected faster than varus. Valgus correction in the distal femur/proximal tibia as well as varus correction in the tibia in idiopathic patients is highly predictable. The constant derived is the first tool which enables predicting and monitoring amount of correction in hemiepiphysiodesis when correcting angular deformities around the knee.
IV.
评估特发性膝内翻/外翻行股骨远端半骨骺阻滞术后事件的时间和空间顺序。
这是一项对206例患者的372个骨骺进行的回顾性多中心研究。计算平均矫正率（ROC）；进行单因素和多因素分析。
总体而言，92%的股骨骨骺随访时间超过一年/达到骨骼成熟。其中，93%矫正至机械性股骨远端外侧角（mLDFA）为85°至89°；2%未矫正，5%矫正过度。共有92%的胫骨骨骺随访时间超过一年/达到骨骼成熟。其中，92%矫正至机械性胫骨近端内侧角（mMPTA）为85°至89°；2%未矫正，6%矫正过度。显著影响成功和ROC的因素为年龄、畸形方向和程度。股骨ROC显著快于胫骨ROC：分别为0.85°/月和0.78°/月（p = 0.05）。股骨外翻ROC显著快于内翻ROC：分别为0.90°/月和0.77°/月（p = 0.04）。得出一个常数来计算矫正量。在第一年的外翻畸形中，计算得到的mLDFA与实际mLDFA之间存在显著相关性（r = 0.58至0.87，p < 0.01）。内翻畸形的计算mLDFA与实际mLDFA不相关。在计算所有畸形的mMPTA矫正时发现显著相关性。
股骨矫正比胫骨快；股骨外翻畸形矫正比内翻快。特发性患者股骨远端/胫骨近端的外翻矫正以及胫骨的内翻矫正具有高度可预测性。得出的常数是在矫正膝关节周围角状畸形时预测和监测半骨骺阻滞矫正量的首个工具。
IV级。
