张力带钢板用于肢体长度差异矫正。
Tension-band Plating for Leg-length Discrepancy Correction.
作者信息
Tolk Jaap J, Merchant Rajiv, Calder Peter R, Hashemi-Nejad Aresh, Eastwood Deborah M
机构信息
Department of Orthopaedics and Sports Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, South Holland, Netherlands; Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
Catterall Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom; Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
出版信息
Strategies Trauma Limb Reconstr. 2022 Jan-Apr;17(1):19-25. doi: 10.5005/jp-journals-10080-1547.
AIM
Dual tension-band plates are used for temporary epiphysiodesis and longitudinal guided growth. The study aim was to assess rate of correction, to identify development of femoral and tibial intra-articular deformity during correction and to document resumption of growth after plate removal.
MATERIALS AND METHODS
A retrospective study of 34 consecutive patients treated with dual tension-band plates between 2012 and 2020 was performed. Twenty-four patients had surgery at the distal femur, six at the proximal tibia and four at both. Twenty-five female patients were treated at a mean age of 11.6 (±1.4) years and nine male patients at 13.5 (±1.5) years. Measurements were performed on standardised long-leg radiographs and included leg-length discrepancy (LLD), joint line congruency angle (JLCA), tibial roof angle, femoral floor angle and notch-intercondylar distance. Measurements were taken pre-operatively, at the end of discrepancy correction and at skeletal maturity.
RESULTS
The LLD reduced by a mean of 12.9 mm (95% CI 10.2-15.5) with the mean residual difference 8.4 mm (95% CI 5.4-11.4). The mean correction rate for the proximal tibia was 0.40 (SD 0.33) mm/month and 0.68 (SD 0.36) mm/month for the distal femur. A significant mean change in residual LLD [-2.5 mm (95% CI -4.2 to -0.7)] was observed between plate removal and skeletal maturity at the femoral level only. After length discrepancy correction, the tibial roof angle showed a significant difference of 8.4° (95% CI 13.4-3.4) between legs. In femoral epiphysiodesis patients, no important differences were observed.
CONCLUSION
A significant reduction in LLD can be achieved using dual tension-band plating. A change in intra-articular morphology was observed only in the proximal tibia and not in the distal femur. In the authors' opinion, tension-band plating is a useful tool for leg-length equalisation but should be reserved for younger patients or when residual growth is difficult to predict. It is one of the management strategies for limb-length difference prior to skeletal maturity.
HOW TO CITE THIS ARTICLE
Tolk JJ, Merchant R, Calder PR, . Tension-band Plating for Leg-length Discrepancy Correction. Strategies Trauma Limb Reconstr 2022;17(1):19-25.
目的
双张力带钢板用于临时骨骺阻滞和纵向引导生长。本研究的目的是评估矫正率，确定矫正过程中股骨和胫骨关节内畸形的发展情况，并记录钢板取出后生长的恢复情况。
材料与方法
对2012年至2020年间连续接受双张力带钢板治疗的34例患者进行回顾性研究。24例患者在股骨远端进行手术，6例在胫骨近端进行手术，4例在两处均进行手术。25例女性患者的平均治疗年龄为11.6（±1.4）岁，9例男性患者为13.5（±1.5）岁。在标准化的长腿X线片上进行测量，包括腿长差异（LLD）、关节线一致性角（JLCA）、胫骨顶角度、股骨底角度和髁间切迹距离。术前、差异矫正结束时和骨骼成熟时进行测量。
结果
LLD平均减少12.9 mm（95%可信区间10.2 - 15.5），平均残留差异为8.4 mm（95%可信区间5.4 - 11.4）。胫骨近端的平均矫正率为0.40（标准差0.33）mm/月，股骨远端为0.68（标准差0.36）mm/月。仅在股骨水平，观察到钢板取出和骨骼成熟之间残留LLD有显著的平均变化[-2.5 mm（95%可信区间 - 4.2至 -
0.7）]。在长度差异矫正后，双腿之间的胫骨顶角度显示出8.4°（95%可信区间13.4 - 3.4）的显著差异。在股骨骨骺阻滞患者中，未观察到重要差异。
结论
使用双张力带钢板固定可显著降低LLD。仅在胫骨近端观察到关节内形态的变化，而在股骨远端未观察到。作者认为，张力带钢板固定是实现腿长均衡的有用工具，但应保留给年轻患者或残留生长难以预测的情况。它是骨骼成熟前肢体长度差异的治疗策略之一。
如何引用本文
Tolk JJ, Merchant R, Calder PR, . 张力带钢板固定矫正腿长差异。《创伤肢体重建策略》2022；17(1):19 - 25。
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