Cheng You-Hung, Lee Wei-Chun, Tsai Yi-Feng, Kao Hsuan-Kai, Yang Wen-E, Chang Chia-Hsieh
Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
J Child Orthop. 2021 Apr 19;15(2):106-113. doi: 10.1302/1863-2548.15.200180.
This study aimed to compare the efficacy of decreasing leg-length discrepancy (LLD) and postoperative complications between tension band plates (TBP) and percutaneous transphyseal screws (PETS).
This retrospective study reviewed LLD patients who underwent temporary epiphysiodesis at the distal femur and/or proximal tibia from 2010 to 2017 (minimum two years follow-up). Efficacy of decreasing LLD was assessed one and two years postoperatively. Complications were classified with the modified Clavien-Dindo-Sink complication classification system. Knee deformities were assessed by percentile and zone of mechanical axis across the tibial plateau.
In total, 53 patients (25 boys, 28 girls) underwent temporary epiphysiodesis (mean age, 11.4 years). The efficacy of decreasing LLD at two years between the TBP (n = 38) and PETS (n = 15) groups was comparable. Seven grade III complications were recorded in six TBP patients and in one PETS patient who underwent revision surgeries for knee deformities and physis impingement. Four grade I and two grade II complications occurred in the TBP group. The mechanical axis of the leg shifted laterally in the PETS group and medially in the TBP groups (+7.1 percentile -4.2 percentile; p < 0.05). Shifting of the mechanical axis by two zones was noted medially in four TBP patients and laterally in two PETS patients.
More implant-related complications and revision surgeries for angular deformities were associated with TBP. A tendency of varus and valgus deformity after epiphysiodesis using TBP and PETS was observed, respectively. Patients and families should be informed of the risks and regular postoperative follow-up is recommended.
Level III.
本研究旨在比较张力带钢板（TBP）与经皮经骨骺螺钉（PETS）在减少下肢长度差异（LLD）方面的疗效以及术后并发症情况。
这项回顾性研究纳入了2010年至2017年期间在股骨远端和/或胫骨近端接受临时骨骺阻滞术的LLD患者（至少随访两年）。术后1年和2年评估减少LLD的疗效。并发症采用改良的Clavien-Dindo-Sink并发症分类系统进行分类。通过胫骨平台机械轴的百分位数和区域评估膝关节畸形。
共有53例患者（25例男孩，28例女孩）接受了临时骨骺阻滞术（平均年龄11.4岁）。TBP组（n = 38）和PETS组（n = 15）在两年时减少LLD的疗效相当。6例TBP患者和1例PETS患者出现7例III级并发症，这些患者因膝关节畸形和骨骺撞击接受了翻修手术。TBP组发生4例I级和2例II级并发症。PETS组下肢机械轴向外移位，TBP组向内移位（+7.1百分位数对 -4.2百分位数；p < 0.05）。4例TBP患者机械轴向内移位两个区域，2例PETS患者向外移位两个区域。
TBP与更多的植入物相关并发症和角畸形翻修手术有关。分别观察到使用TBP和PETS进行骨骺阻滞后出现内翻和外翻畸形的趋势。应告知患者及其家属相关风险，建议定期进行术后随访。
III级。
