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经骨骺螺钉经皮骨骺阻滞治疗膝外翻或膝内翻的影响因素及矫正率

Affecting Factors and Correction Ratio in Genu Valgum or Varum Treated with Percutaneous Epiphysiodesis Using Transphyseal Screws.

作者信息

Lee Si-Wook, Lee Kyung-Jae, Cho Chul-Hyun, Ye Hee-Uk, Yon Chang-Jin, Choi Hyeong-Uk, Kim Young-Hun, Song Kwang-Soon

机构信息

Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea.

出版信息

J Clin Med. 2020 Dec 18;9(12):4093. doi: 10.3390/jcm9124093.

Abstract

This study evaluated the correction rates of idiopathic genu valgum or varum after percutaneous epiphysiodesis using transphyseal screws (PETS) and analyzed the affecting factors. A total of 35 children without underlying diseases were enrolled containing 64 physes (44 distal femoral (DT), 20 proximal tibial (PT)). Anatomic tibiofemoral angle (aTFA) and the mechanical axis deviation (MAD) were taken from teleroentgenograms before PETS surgery and screw removal. The correction rates of the valgus and varus deformities for patients treated with PETS were 1.146°/month and 0.639°/month using aTFA while using MAD showed rates of 4.884%/month and 3.094%/month. After aTFA ( < 0.001) and MAD ( < 0.001) analyses, the correction rate of DF was significantly faster than that of PT. Under multivariable analysis, the aTFA correction rate was significantly faster in younger patients ( < 0.001), in males ( < 0.001), in patients with lower weights ( < 0.001), and in the group that was screwed at DF ( < 0.001). Meanwhile, the MAD correction rate was significantly faster in patients with lower heights ( = 0.003). PETS is an effective treatment method for valgus and varus deformities in growing children and clinical characters should be considered to estimate the correction rate.

摘要

本研究评估了经皮骨骺阻滞术使用经骨骺螺钉(PETS)治疗特发性膝外翻或膝内翻后的矫正率,并分析了影响因素。共纳入35例无基础疾病的儿童,包含64个骨骺(44个股骨远端(DT),20个胫骨近端(PT))。在PETS手术前及取出螺钉前,从远距离X线片获取解剖学胫股角(aTFA)和机械轴偏移(MAD)。使用aTFA时,PETS治疗患者的外翻和内翻畸形矫正率分别为1.146°/月和0.639°/月,而使用MAD时,矫正率分别为4.884%/月和3.094%/月。经aTFA(<0.001)和MAD(<0.001)分析后,股骨远端的矫正率明显快于胫骨近端。在多变量分析中,年龄较小的患者(<0.001)、男性(<0.001)、体重较低的患者(<0.001)以及在股骨远端拧入螺钉的组(<0.001)中,aTFA矫正率明显更快。同时,身高较低的患者MAD矫正率明显更快(=0.003)。PETS是治疗生长中儿童外翻和内翻畸形的有效方法,应考虑临床特征来评估矫正率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0755/7766970/742a12d39a95/jcm-09-04093-g001.jpg

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