Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital.
Department of Mathematics, College of Natural Sciences, Ajou University, Gyeonggi, Korea.
J Pediatr Orthop. 2021;41(10):e899-e903. doi: 10.1097/BPO.0000000000001970.
This study investigated the effect of screw configuration on the rate of correction of coronal angular deformity of the knee joint in children who underwent guided growth using the tension-band plate.
Consecutive patients (76 patients with 154 physes; mean age: 11.8±2.2 y) who underwent guided growth using the tension-band plate for coronal angular deformity (genu varum or genu valgum) were included. The mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and screw angle were measured from the teleroentgenograms of preoperative and postoperative periodic follow-up visits.
The mean initial screw angle and the mean rate of correction were 16.7±10.5 degrees and 6.5±5.3 degrees per year, respectively. The rate of correction was significantly affected by age at surgery, sex, physis treated, severity of deformity, and rate of change in screw angle (all P<0.001). However, the initial screw angle and type of deformity did not affect the rate of correction. The rate of correction per year was 3.6 degrees higher in boys than in girls and 2.8 degrees higher in the distal femur than in the proximal tibia. A 1 degree increase in the rate of change in screw angle was associated with a 0.5 degree increase in the correction rate. Screw angle significantly increased with follow-up duration (P<0.001) and the change in screw angle was significantly affected by age, sex, and physis treated (all P<0.001).
This study demonstrated that screw configuration did not affect the correction rate of coronal angular deformity for guided growth using the tension-band plate. Therefore, surgeons only need to insert the screws according to anatomic restriction, not considering the screw configuration when using the tension-band plate for guided growth in children.
Prognostic level III.
本研究旨在探讨在使用张力带钢板进行儿童膝关节冠状面角度畸形引导生长中，螺钉构型对膝关节冠状面角度畸形矫正率的影响。
本研究纳入了连续接受张力带钢板治疗冠状面角度畸形（膝内翻或膝外翻）的患儿（76 例患者，154 个骨骺；平均年龄：11.8±2.2 岁）。从术前和术后定期随访的正位 X 线片上测量机械外侧股骨远端角、机械内侧胫骨近端角和螺钉角度。
平均初始螺钉角度和平均矫正率分别为 16.7±10.5 度和 6.5±5.3 度/年。矫正率受手术时年龄、性别、治疗骨骺、畸形严重程度和螺钉角度变化率的显著影响（均 P<0.001）。然而，初始螺钉角度和畸形类型并不影响矫正率。与女孩相比，男孩的矫正率每年高出 3.6 度，股骨远端比胫骨近端高出 2.8 度。螺钉角度变化率每增加 1 度，矫正率就增加 0.5 度。螺钉角度随随访时间显著增加（P<0.001），且螺钉角度的变化受年龄、性别和治疗骨骺的影响（均 P<0.001）。
本研究表明，在使用张力带钢板进行儿童膝关节冠状面角度畸形引导生长中，螺钉构型并不影响冠状面角度畸形的矫正率。因此，在使用张力带钢板进行儿童膝关节冠状面角度畸形引导生长时，外科医生只需根据解剖学限制插入螺钉，而无需考虑螺钉构型。
预后 III 级。
