Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
J Am Acad Orthop Surg Glob Res Rev. 2020 Jan 6;4(1). doi: 10.5435/JAAOSGlobal-D-19-00009. eCollection 2020 Jan.
To report prospectively the radioclinical outcome of guided growth surgery for coronal plane deformities around the knee in young children with nutritional rickets on the intermediate term, to assess the responsiveness of torsional deformities of the tibias to guided growth regarding function and objective clinical parameters, and to propose a treatment algorithm.
Fifty children (male:female, 27:23) with knee coronal plane deformities (knees:physes, 86:99), (varum:valgum, 51:35) secondary to nutritional rickets were subjected to femoral and/or tibial temporary hemiepiphysiodesis using a two-hole 8-plate. The mean age at implantation was 3.8 ± 1.5 years (range 2.5 to 5). The mean follow-up was 2.8 years (range 2 to 4). All children received a standing full-length AP radiographs of both lower limbs in neutral rotation to measure the mechanical axis deviation, tibiofemoral angle, and joint orientation angles. Tibial torsion was objectively assessed by measuring the bimalleolar axis.
The radiologic measurements, tibiofemoral angle, mechanical axis deviation, mechanical lateral distal femoral angle, medial proximal tibial angle, and Hilgenreiner-epiphyseal angle, showed a highly statistically significant improvement ( ≤ 0.001). Radiographic outcomes correlated with their clinical counterparts. The mean duration of correction of the mechanical axis was 10.8 ± 2.4 months (7 to 21). The mean follow-up for rebound of the deformity was 1.5 years (range 1 to 3).
The radioclinical outcome is rewarding with a tolerable complication profile. The mechanical complications were mostly related to lengthy implant retainment encountered in severe deformities. Internal tibial torsion seems profoundly responsive to correction of coronal plane deformity. And, derotation osteotomies are rarely justified. Our proposed algorithm may be used as a decision-taking guide for achieving the desired growth modulation in a more efficient manner.
报告儿童营养性佝偻病膝关节冠状面畸形引导生长手术的中期放射临床结果，评估引导生长对胫骨扭转畸形的反应性，以功能和客观临床参数为依据，并提出治疗方案。
50 例（男/女：27/23）膝关节冠状面畸形（膝/骨骺：86/99）（膝内翻/外翻：51/35）的儿童因营养性佝偻病行股骨和/或胫骨临时半骺阻滞术，采用 2 孔 8 板。植入时的平均年龄为 3.8 ± 1.5 岁（范围 2.5 至 5 岁）。平均随访时间为 2.8 年（范围 2 至 4 年）。所有儿童均接受中立位旋转站立位双下肢全长前后位 X 线片，以测量机械轴偏差、胫股角和关节对线角度。胫骨扭转通过测量双踝轴进行客观评估。
影像学测量、胫股角、机械轴偏差、机械外侧股骨远端角、内侧胫骨近端角和 Hilgenreiner 骺板角均有高度统计学意义的改善（≤0.001）。影像学结果与临床结果相关。机械轴矫正的平均持续时间为 10.8 ± 2.4 个月（7 至 21 个月）。畸形复发的平均随访时间为 1.5 年（范围 1 至 3 年）。
放射临床结果令人满意，并发症发生率可接受。机械并发症主要与严重畸形时较长的植入物保留有关。胫骨内旋似乎对冠状面畸形的矫正有明显的反应性。并且，很少需要进行旋转移位截骨术。我们提出的算法可作为决策指南，以更有效的方式实现所需的生长调节。
