法西耶-迪瓦尔型杆断裂：是否与远侧干骺端的定位有关？
Fassier-Duval Rod Failure: Is It Related to Positioning in the Distal Epiphysis?
机构信息
Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado.
Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO.
出版信息
J Pediatr Orthop. 2020 Sep;40(8):448-452. doi: 10.1097/BPO.0000000000001513.
BACKGROUND
The relationship between Fassier-Duval (FD) rod placement and rod failure rates has not previously been quantified.
METHODS
Retrospective review was conducted on patients with osteogenesis imperfecta treated with FD rods between 2005 and 2017. Age at first surgery, sex, Sillence type of osteogenesis imperfecta, bisphosphonate treatment, location of rod (side of body and specific bone), and dates of surgeries, radiographs, and rod failures were collected. C-arm images determined rod fixation within the distal epiphysis at the time of surgery. C-arm variables included rod deviation (percent deviation from the midline of the distal epiphysis) and anatomical direction of deviation (anterior/posterior and medial/lateral). X-ray images were examined for rod failure, which was defined as bending, pulling out of the physis, protrusion out of the bone, and/or failure to telescope. Cox proportional hazards regression models were used to compare failure rates with location of placement within the distal epiphysis allowing for clustering of the data by side (left or right) and bone (femur or tibia).
RESULTS
The cohort was 13 patients (11 female individuals and 2 male individuals) with a total of 66 rods and 75 surgeries. Mean time from the first surgery to the last follow-up visit was 8.9 years (SD=5 y). There was a 7% increase in hazard of failure per 1-mm increase in antero-posterior (AP) deviation [hazard ratio (HR), 1.07; 95% confidence interval (CI), 1.01-1.14; P=0.029)]. Similarly, there was a 9% increase in hazard of failure for every 1-mm increase in lateral deviation (HR, 1.09; 95% CI, 1.01-1.18; P=0.019). A 12% increase in hazard of failure per 10% increase in deviation from the midline for both AP and lateral radiograph views was also found, although this was only statistically significant for lateral deviation on the AP radiograph view (HR, 1.12; 95% CI, 1.01-1.25; P=0.030).
CONCLUSIONS
FD rod placement within the distal epiphysis has significant impact on increasing rod survival.
LEVEL OF EVIDENCE
Level III-therapeutic study.
背景
Fassier-Duval（FD）杆放置位置与杆失败率之间的关系尚未得到量化。
方法
对 2005 年至 2017 年间接受 FD 杆治疗的成骨不全症患者进行回顾性研究。收集患者的首次手术年龄、性别、成骨不全症的 Sillence 类型、双膦酸盐治疗、杆的位置（身体侧面和特定骨）以及手术日期、X 射线和杆失败的日期。C 臂影像确定手术时杆在远端骺板内的固定位置。C 臂变量包括杆偏差（从远端骺板中线的百分比偏差）和偏差的解剖方向（前后和内外）。X 射线图像检查杆的失败情况，定义为弯曲、穿出骺板、突出骨骼和/或不能伸缩。使用 Cox 比例风险回归模型比较失败率与远端骺板内放置位置的关系，允许通过侧（左侧或右侧）和骨（股骨或胫骨）对数据进行聚类。
结果
该队列包括 13 名患者（11 名女性和 2 名男性），共 66 根杆和 75 次手术。从第一次手术到最后一次随访的平均时间为 8.9 年（标准差=5 年）。前-后（AP）偏差每增加 1 毫米，失败的风险增加 7%[风险比（HR），1.07；95%置信区间（CI），1.01-1.14；P=0.029]。同样，外侧偏差每增加 1 毫米，失败的风险增加 9%（HR，1.09；95%CI，1.01-1.18；P=0.019）。还发现，AP 和侧位 X 线片上偏离中线的偏差每增加 10%，失败的风险增加 12%，尽管这仅在 AP 侧位 X 线片上的外侧偏差上具有统计学意义（HR，1.12；95%CI，1.01-1.25；P=0.030）。
结论
FD 杆在远端骺板内的放置位置对提高杆的存活率有显著影响。
证据水平
III 级治疗研究。
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