Hospital San Juan de Dios, Pamplona.
Department of Orthopaedics. University of Navarra, Pamplona, Spain.
Curr Opin Pediatr. 2021 Feb 1;33(1):79-89. doi: 10.1097/MOP.0000000000000990.
Premature Physeal Closure (PPC) is the most common consequence of a mostly posttraumatic, physeal injury. They are of utmost importance because they can significantly alter physeal function and lead to disorders such as limb length discrepancies and angular deformities.
The type of physeal fracture has not demonstrated a solid predictive value in the formation of PPC, especially in the knee where almost any type of fracture can produce it. The detection of physeal damage with imaging tests (simple radiology and MRI) is very accurate; however, their predictive capacity to foretell which injury will generate a physeal bridge is still poor. For this reason, it is not advisable to make surgical decisions at the first medical assessment. Direct surgical management of PPC's (resection-interposition technique) has generally shown high unpredictability. Nevertheless, the latest interposition materials (chondrocytes and mesenchymal stem cells) showed promising results.
PPC is an often devastating consequence of physeal injury and as such deserves further research. To date little is known about etiopathogenesis, risk factors and natural history among other aspects. Until direct surgery offers more consistent results, acute osteotomies and bone distraction for progressive correction continue to be the most widespread treatments for PPCs.
骺板过早融合（PPC）是最常见的创伤后骺板损伤的后果。它们非常重要，因为它们会显著改变骺板的功能，并导致肢体长度差异和角度畸形等疾病。
骺板骨折的类型并不能在 PPC 的形成中提供可靠的预测价值，尤其是在膝关节中，几乎任何类型的骨折都可能导致 PPC。影像学检查（普通放射学和 MRI）对骺板损伤的检测非常准确；然而，其预测哪种损伤会导致骺板桥接的能力仍然较差。因此，在第一次医疗评估时不建议做出手术决定。PPC 的直接手术治疗（切除-间置技术）通常显示出高度的不可预测性。然而，最新的间置材料（软骨细胞和间充质干细胞）显示出有希望的结果。
PPC 是骺板损伤的一种常见且破坏性的后果，因此值得进一步研究。迄今为止，人们对其病因发病机制、危险因素和自然史等方面知之甚少。在直接手术提供更一致的结果之前，急性截骨术和骨牵引术用于进行性矫正仍然是 PPC 最广泛的治疗方法。
