Schlemmer Thomas, Brunner Reinald, Speth Bernhard, Mayr Johannes, Rutz Erich
Neuroorthopedics, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland.
Faculty of Medicine, The University of Basel, 4001 Basel, Switzerland.
Children (Basel). 2021 Jan 27;8(2):86. doi: 10.3390/children8020086.
Supramalleolar osteotomy (SMO) in pediatric patients can be fixed in various ways. We analyzed the records of 77 pediatric patients (124 SMOs) aged ≤16 years. In 56 patients (96 SMOs), K-wires were used to stabilize SMOs (WF group), while 21 patients (28 SMOs) were treated with locking compression plates (LCPs; PF group). We recorded time to radiographic consolidation, rate of complications, length of hospital stay (LOS), and time to implant removal. Mean time to radiographic consolidation of SMOs was 7.2 weeks in the WF group and 11.1 weeks in the PF group. Complication rate in the WF group was 10.7%. LOS was similar in the two groups (7.0 days in the WF group vs. 7.3 days in the PF group). K-wire stabilization resulted in a shortened interval until consolidation of osteotomies, but children were required to use a cast. Stabilization of SMOs with LCPs facilitated early mobilization and functional rehabilitation with no need to apply a cast. In conclusion, both methods provided safe fixation of SMOs with a low rate of complications. K-wire stabilization combined with a cast achieves fast consolidation of SMOs. We recommend SMO stabilization with angular stable LCPs in patients with muscular weakness or spasticity in whom early mobilization and physiotherapy are necessary to prevent loss of muscle power, muscle function, and bone mass.
小儿患者的踝关节上截骨术（SMO）可用多种方式固定。我们分析了77例年龄≤16岁的小儿患者（124例SMO）的记录。56例患者（96例SMO）采用克氏针固定SMO（克氏针组），而21例患者（28例SMO）采用锁定加压钢板治疗（锁定加压钢板组；PF组）。我们记录了影像学愈合时间、并发症发生率、住院时间（LOS）和植入物取出时间。SMO的影像学平均愈合时间在克氏针组为7.2周，在PF组为11.1周。克氏针组的并发症发生率为10.7%。两组的住院时间相似（克氏针组为7.0天，PF组为7.3天）。克氏针固定可缩短截骨愈合间隔，但患儿需要使用石膏。用锁定加压钢板固定SMO便于早期活动和功能康复，无需使用石膏。总之，两种方法都能安全固定SMO，并发症发生率低。克氏针固定结合石膏可使SMO快速愈合。对于肌肉无力或痉挛的患者，我们建议使用角度稳定的锁定加压钢板固定SMO，这类患者需要早期活动和物理治疗以防止肌肉力量、肌肉功能和骨量丧失。
