Children's Orthopaedics, Deformity Correction and Foot Surgery, University Hospital of Muenster, Muenster, Germany.
General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany.
Bone Joint J. 2021 Aug;103-B(8):1428-1437. doi: 10.1302/0301-620X.103B8.BJJ-2020-1035.R4.
Temporary epiphysiodesis (ED) is commonly applied in children and adolescents to treat leg length discrepancies (LLDs) and tall stature. Traditional Blount staples or modern two-hole plates are used in clinical practice. However, they require accurate planning, precise surgical techniques, and attentive follow-up to achieve the desired outcome without complications. This study reports the results of ED using a novel rigid staple (RigidTack) incorporating safety, as well as technical and procedural success according to the idea, development, evaluation, assessment, long-term (IDEAL) study framework.
A cohort of 56 patients, including 45 unilateral EDs for LLD and 11 bilateral EDs for tall stature, were prospectively analyzed. ED was performed with 222 rigid staples with a mean follow-up of 24.4 months (8 to 49). Patients with a predicted LLD of ≥ 2 cm at skeletal maturity were included. Mean age at surgery was 12.1 years (8 to 14). Correction and complication rates including implant-associated problems, and secondary deformities as well as perioperative parameters, were recorded (IDEAL stage 2a). These results were compared to historical cohorts treated for correction of LLD with two-hole plates or Blount staples.
The mean LLD was reduced from 25.2 mm (15 to 45) before surgery to 9.3 mm (6 to 25) at skeletal maturity. Implant-associated complications occurred in 4/56 treatments (7%), and secondary frontal plane deformities were detected in 5/45 legs (11%) of the LLD cohort. Including tall stature patients, the rate increased to 12/67 legs (18%). Sagittal plane deformities were observed during 1/45 LLD treatments (2%). Compared to two-hole plates and Blount staples, similar correction rates were observed in all devices. Lower rates of frontal and sagittal plane deformities were observed using rigid staples.
Treatment of LLD using novel rigid staples appears a feasible and promising strategy. Secondary frontal and sagittal plane deformities remain a potential complication, although the rate seems to be lower in patients treated with rigid staples. Further comparative studies are needed to investigate this issue. Cite this article: 2021;103-B(8):1428-1437.
临时骺板切除术（ED）常用于儿童和青少年，以治疗肢体长度差异（LLD）和身材过高。在临床实践中，传统的 Blount 钉或现代的两孔钢板都有应用。然而，它们需要精确的规划、精确的手术技术和细心的随访，以在没有并发症的情况下达到预期的结果。本研究根据 IDEAL 研究框架（理念、开发、评估、长期评估）报告了使用新型刚性钉（RigidTack）进行 ED 的结果，该钉具有安全性，以及技术和程序上的成功。
前瞻性分析了 56 例患者，包括 45 例单侧 ED 治疗 LLD 和 11 例双侧 ED 治疗身材过高。ED 采用 222 个刚性钉，平均随访 24.4 个月（8 至 49 个月）。纳入预计在骨骼成熟时 LLD≥2cm 的患者。手术时的平均年龄为 12.1 岁（8 至 14 岁）。记录了矫正和并发症发生率，包括与植入物相关的问题、继发性畸形以及围手术期参数（IDEAL 阶段 2a）。将这些结果与使用两孔钢板或 Blount 钉治疗 LLD 的历史队列进行比较。
术前 LLD 平均值为 25.2mm（15 至 45），骨骼成熟时为 9.3mm（6 至 25）。56 例治疗中有 4 例（7%）出现与植入物相关的并发症，45 例 LLD 队列中有 5 例（11%）出现继发性额状面畸形。包括身材过高的患者，发生率增加至 67 例中的 12 例（18%）。45 例 LLD 中有 1 例（2%）出现矢状面畸形。与两孔钢板和 Blount 钉相比，所有装置的矫正率相似。刚性钉的额状面和矢状面畸形发生率较低。
使用新型刚性钉治疗 LLD 似乎是一种可行且有前途的策略。继发性额状面和矢状面畸形仍然是一个潜在的并发症，尽管在接受刚性钉治疗的患者中，发生率似乎较低。需要进一步的比较研究来调查这个问题。引用本文：2021；103-B（8）：1428-1437.
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