Department of Paediatric Orthopaedics, Altonaer Children's Hospital, Hamburg, Germany.
Department of Traumatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Bone Joint J. 2020 Oct;102-B(10):1412-1418. doi: 10.1302/0301-620X.102B10.BJJ-2020-0473.R1.
Eight-plates are used to correct varus-valgus deformity (VVD) or limb-length discrepancy (LLD) in children and adolescents. It was reported that these implants might create a bony deformity within the knee joint by change of the roof angle (RA) after epiphysiodesis of the proximal tibia following a radiological assessment limited to anteroposterior (AP) radiographs. The aim of this study was to analyze the RA, complemented with lateral knee radiographs, with focus on the tibial slope (TS) and the degree of deformity correction.
A retrospective, single-centre study was conducted. The treatment group (n = 64 knees in 44 patients) was subclassified according to the implant location in two groups: 1) medial hemiepiphysiodesis; and 2) lateral hemiepiphysiodesis. A third control group consisted of 25 untreated knees. The limb axes and RA were measured on long standing AP leg radiographs. Lateral radiographs of 40 knees were available for TS analysis. The mean age of the patients was 10.6 years (4 to 15) in the treatment group and 8.4 years (4 to 14) in the control group. Implants were removed after a mean 1.2 years (0.5 to 3).
No significant differences in RA (p = 0.174) and TS (p = 0.787) were observed. The limb axes were significantly corrected in patients with VVD (p < 0.001). The change in tibial slope (∆TS) did not correlate ( = -0.026; p = 0.885) to the plate's position on the physis when assessed by lateral radiographs.
We were not able to confirm the reported change in the bony morphology of the proximal tibia on AP radiographs in our patient population. In addition, no significant change in TS was detected on the lateral radiographs. A significant correction of the VVD in the lower limb axes was evident. Position of the implant did not correlate with TS change. Therefore, eight-plate epiphysiodesis is a safe and effective procedure for correcting VVD in children without disturbing the knee joint morphology. Cite this article: 2020;102-B(10):1412-1418.
八板用于矫正儿童和青少年的内翻-外翻畸形（VVD）或肢体长度差异（LLD）。据报道，这些植入物可能会通过改变胫骨近端骺板融合后的顶角度（RA），在影像学评估仅限于前后位（AP）射线照相时在膝关节内造成骨畸形。本研究的目的是分析 RA，并结合侧膝关节射线照相，重点分析胫骨斜率（TS）和畸形矫正程度。
回顾性、单中心研究。治疗组（44 名患者 64 膝）根据植入物位置分为两组：1）内侧骺板融合术；和 2）外侧骺板融合术。第三组对照组包括 25 例未经治疗的膝关节。在长期站立的 AP 腿部射线照相上测量肢体轴和 RA。40 个膝关节的侧位片可用于 TS 分析。患者的平均年龄为治疗组 10.6 岁（4 至 15 岁）和对照组 8.4 岁（4 至 14 岁）。植入物在平均 1.2 年后（0.5 至 3 年）被取出。
RA（p = 0.174）和 TS（p = 0.787）无显著差异。VVD 患者的肢体轴显著矫正（p < 0.001）。侧位片评估时，胫骨斜率的变化（∆TS）与骺板的位置无相关性（ = -0.026；p = 0.885）。
我们无法在我们的患者群体中证实报告的胫骨近端骨形态变化。此外，侧位片上未检测到 TS 的显著变化。下肢轴 VVD 的显著矫正明显。植入物的位置与 TS 变化无关。因此，八板骺板融合术是一种安全有效的治疗儿童 VVD 的方法，不会干扰膝关节形态。
2020；102-B（10）：1412-1418。
