Baraka Mostafa M, Hefny Hany M, Mahran Mahmoud A, Fayyad Tamer A, Abdelazim Haytham, Nabil Amr
Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
J Child Orthop. 2021 Feb 1;15(1):12-23. doi: 10.1302/1863-2548.15.200157.
Surgical treatment in advanced-stage infantile Blount's disease with medial plateau (MP) depression is challenging. Several osteotomies and fixation methods have been described with no established benchmark. We conducted this study to evaluate the efficacy and safety of a new single-stage technique for acute medial condyle elevation and metaphyseal osteotomies with internal fixation.
A prospective case series of 19 consecutive patients (21 knees) with severe infantile Blount's disease underwent a single-stage MP elevation and metaphyseal osteotomies, with internal fixation. The mean age was 10.3 years (8.2 to 13.6) and the mean follow-up was 5.1 years (3.2 to 8.3). The outcome measures included clinical and radiological parameters and patient-reported pediatric outcomes data collection instrument (PODCI) score.
The mean PODCI score improved significantly from 50% to 88%. The mean internal tibial torsion improved from -27° to 11°. All cases maintained full knee extension, no limitation in flexion range of movement and no signs of instability or lateral thrust gait. All the radiographic parameters improved significantly; the mean tibiofemoral angle improved from -29° to 7°, the metaphyseal-diaphyseal angle improved from 33.4° to 4.7° and the angle of depressed MP improved from 38.3° to 2.4° (p < 0.001). At the latest follow-up, no cases of deformity recurrence were identified, the final limb-length discrepancy was < 1 cm in all patients.
Single-stage MP elevation and metaphyseal osteotomies with internal fixation significantly improved the clinical and radiographic parameters and PODCI score in advanced infantile Blount's disease and precluded the use of external immobilization, with no evidence of deformity recurrence.
IV.
晚期婴儿型Blount病合并内侧平台（MP）凹陷的手术治疗具有挑战性。已有多种截骨术和固定方法的描述，但尚无既定的标准。我们开展这项研究以评估一种新的单阶段技术用于急性内侧髁抬高和干骺端截骨并内固定的疗效和安全性。
对19例连续的重度婴儿型Blount病患者（21膝）进行前瞻性病例系列研究，采用单阶段MP抬高和干骺端截骨并内固定。平均年龄为10.3岁（8.2至13.6岁），平均随访时间为5.1年（3.2至8.3年）。结果指标包括临床和放射学参数以及患者报告的儿童结局数据收集工具（PODCI）评分。
平均PODCI评分从50%显著提高到88%。平均胫骨内旋从-27°改善到11°。所有病例均保持膝关节完全伸直，活动度屈曲范围无受限，无不稳定或外侧推力步态的迹象。所有放射学参数均显著改善；平均胫股角从-29°改善到7°，干骺端-骨干角从33.4°改善到4.7°，凹陷MP角从38.3°改善到2.4°（p<0.001）。在最近一次随访时，未发现畸形复发病例，所有患者最终肢体长度差异<1cm。
单阶段MP抬高和干骺端截骨并内固定显著改善了晚期婴儿型Blount病的临床和放射学参数以及PODCI评分，避免了使用外固定，且无畸形复发的证据。
IV级。
