Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht.
Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard.
J Pediatr Orthop B. 2020 Jul;29(4):323-336. doi: 10.1097/BPB.0000000000000677.
Blount's disease or bowed leg deformity, is a unilateral or bilateral growth deformity of the medial proximal tibia that leads to a tibial varus deformity. A distinction can be made in an early and late onset type. The disease seems to have a predisposition for certain descends. Since the first publication of Blount's disease, different hypotheses on the aetiology are proposed but no consensus exists. The objective of this study is to provide an overview of the available hypotheses on the aetiology of Blount's disease since its first description and assessment of the available level of evidence, the quality of evidence and the occurrence of bias supporting these individual hypotheses. A systematic search according to the PRISMA statement was conducted using PubMed, MEDLINE, EMBASE and the Cochrane Library using a broad combination of terminology to ascertain a complete selection. Proper MESH search criteria were formulated and the bibliographic search was limited to English and Dutch language articles. Articles with no mention of aetiology or a disease related to Blount's were excluded. Level of evidence and types of bias were assessed. Thirty-two articles that discuss the aetiology of Blount's disease were selected. A variety of hypotheses was postulated in these articles with most research in the field of increased mechanical pressure (obesity, early walking age) and race (descend). Blount's disease most likely has a multifactorial origin with influence of genetic and racial predisposition, increased mechanical pressure on the growth plate as a consequence of obesity or early walking age and possibly also nutrition. However, the exact aetiology remains unclear, the probable explanation is that multifactorial factors are all contributing to the development of Blount's disease. Histological research has shown that a disorganization of bone and cartilage structures on the medial side of the proximal tibial physis is present in patients with Blount's disease. Based on the available evidence on the aetiology of Blount's disease, we conclude that it is multifactorial. Most papers focus only on one hypotheses of Blount's disease occurrence and all are characterized as low level of evidence. There seems to be a preference for certain descends. Further research on especially genetic predisposition is needed to provide more insight in this factor of Blount's disease.
布拉特氏病或弓形腿畸形，是一种单侧或双侧的胫骨近端内侧生长畸形，导致胫骨内翻畸形。可以区分早期和晚期发病类型。这种疾病似乎与某些种族有关。自布拉特氏病的首次发表以来，提出了不同的病因假说，但没有共识。本研究的目的是提供自布拉特氏病首次描述以来关于其病因的假说概述，并评估现有的证据水平、证据质量和支持这些假说的偏倚发生率。根据 PRISMA 声明，使用 PubMed、MEDLINE、EMBASE 和 Cochrane 图书馆进行了系统搜索，使用了广泛的术语组合，以确保全面选择。制定了适当的 MESH 搜索标准，并将文献检索限制在英语和荷兰语文章。排除了没有提到病因或与布拉特氏病相关疾病的文章。评估了证据水平和偏倚类型。选择了 32 篇讨论布拉特氏病病因的文章。这些文章中提出了多种假说，其中大多数研究集中在机械压力增加（肥胖、早期行走年龄）和种族（下降）方面。布拉特氏病很可能具有多因素起源，遗传和种族易感性、肥胖或早期行走年龄导致生长板机械压力增加以及营养等因素都可能对其产生影响。然而，确切的病因仍不清楚，可能的解释是多因素都促成了布拉特氏病的发展。组织学研究表明，患有布拉特氏病的患者胫骨近端干骺端内侧骺板的骨和软骨结构存在紊乱。基于现有的布拉特氏病病因证据，我们得出结论，其病因是多因素的。大多数论文仅关注布拉特氏病发生的一个假说，且都被归类为低证据水平。似乎存在对某些种族的偏好。需要进一步研究遗传易感性，以更深入了解布拉特氏病的这一因素。
