Stevens Peter, Desperes Matias, McClure Philip K, Presson Angela, Herrick Jennifer
Department of Orthopedics, University of Utah, Salt Lake City, Utah, United States of America.
Strategies Trauma Limb Reconstr. 2022 Jan-Apr;17(1):26-31. doi: 10.5005/jp-journals-10080-1548.
There are several alternative methods for accomplishing epiphysiodesis of the longer limb to address limb length discrepancy (LLD). Consensus is lacking regarding the optimal timing of the intervention and which method is most efficacious. We reviewed a large group of patients with anisomelia treated by tethering with tension band plates (TBP) and who had attained skeletal maturity. We discuss our preferred timing and technique while noting the complications and how they were managed.
With IRB approval, we reviewed 66 subjects including 32 boys and 34 girls, ranging in age from 3 to 16.6 years at the time of physeal tethering, who were destined to have between 2 and 9 cm LLD at maturity. Inclusion criteria were: (1) at least 1 year of predicted growth at the time of tethering; (2) minimum 18-month follow-up and (3) minimum Risser stage 1 (R1) in the last radiologic study. There were 35 distal femoral, 25 pan genu and five proximal tibial procedures. Patients were seen bi-annually with weight-bearing full-length radiographs to ascertain neutral alignment and assess limb lengths.
We defined a successful outcome to be <1.5 cm of residual discrepancy. Iatrogenic mechanical axis deviation, observed in nine patients (five varus and four valgus), was successfully managed by repositioning the implants. While the under-corrected patients presented too late to achieve equalization, they benefited from partial improvement. Due to lack of timely follow-up, one patient over-corrected by 2 cm and had a femoral shortening at the time of correcting contralateral femoral anteversion. One patient required a distal femoral osteotomy to correct recurvatum at maturity.
Properly timed and executed, TBP is an efficacious and reversible means of growth deceleration, rather than growth arrest, that may be applied in a wide age range of patients with modest anisomelia regardless of aetiology. This method offers potential advantages over purportedly rapid and definitive techniques such as percutaneous epiphysiodesis (PE) or percutaneous epiphysiodesis with transphyseal screws (PETS).
Level III. Retrospective series without controls.
Stevens P, Desperes M, McClure PK, Growth Deceleration for Limb Length Discrepancy: Tension Band Plates Followed to Maturity. Strategies Trauma Limb Reconstr 2022;17(1):26-31.
有几种替代方法可用于完成较长肢体的骨骺阻滞以解决肢体长度差异（LLD）。关于干预的最佳时机以及哪种方法最有效，目前尚无共识。我们回顾了一大组接受张力带钢板（TBP）束缚治疗且已达到骨骼成熟的长短腿患者。我们讨论了我们倾向的时机和技术，同时指出了并发症及其处理方式。
经机构审查委员会（IRB）批准，我们回顾了66例受试者，包括32名男孩和34名女孩，骨骺束缚时年龄在3至16.6岁之间，预计成熟时肢体长度差异在2至9厘米之间。纳入标准为：（1）束缚时至少有1年的预计生长时间；（2）至少随访18个月；（3）最后一次影像学检查时Risser分期至少为1期（R1）。其中有35例股骨远端手术、25例全膝关节手术和5例胫骨近端手术。患者每半年进行一次负重全长X线片检查，以确定中立对线并评估肢体长度。
我们将成功的结果定义为残余差异<1.5厘米。9例患者（5例内翻和4例外翻）出现医源性机械轴偏差，通过重新定位植入物成功处理。虽然矫正不足的患者就诊太晚未能实现肢体长度均等化，但他们从部分改善中获益。由于缺乏及时随访，1例患者过度矫正了2厘米，在矫正对侧股骨前倾角时出现了股骨缩短情况。1例患者在成熟时需要进行股骨远端截骨术以矫正膝反屈。
在适当的时机实施，TBP是一种有效且可逆的生长减速方法，而非生长停滞，可应用于年龄范围广泛、肢体长度差异不大且病因各异的患者。与诸如经皮骨骺阻滞（PE）或经皮带骨骺螺钉骨骺阻滞（PETS）等所谓快速且确定性的技术相比，该方法具有潜在优势。
III级。无对照的回顾性系列研究。
史蒂文斯P，德斯佩斯M，麦克卢尔PK，《肢体长度差异的生长减速：张力带钢板随访至成熟》。《创伤肢体重建策略》2022；17(1)：26 - 31。
