Mare Pieter H, Marais Leonard C
Department of Orthopaedic Surgery, Grey's Hospital and University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa.
Department of Orthopaedic Surgery, University of KwaZulu-Natal, Durban, South Africa.
Strategies Trauma Limb Reconstr. 2022 Jan-Apr;17(1):32-37. doi: 10.5005/jp-journals-10080-1549.
To evaluate the results in terms of correction and complications from gradual correction with a computer-assisted hexapod circular external fixator in a mixed cohort of children with Blount's disease.
A retrospective review was performed of the correction and complications of 19 children (25 limbs) with recurrent infantile (IBD) and late-onset Blount's disease (LOBD) treated by gradual correction with a hexapod external fixator. The correction was measured by the medial proximal tibial angle (MPTA), anatomic posterior proximal tibial angle (aPPTA) and anatomic tibio-femoral angle (TFA). Obesity was present in 76% (19/25) of cases. Fifteen limbs were classified as infantile Blount's disease and 10 limbs as late-onset Blount's disease. The mean age was 12.5 years (range 7-17 years).
The mean pre-operative MPTA of 59° (SD 13°, range 33-79°) was corrected to a mean of 86° (SD 5°, range 77-93°). The mean pre-operative aPPTA of 64° (SD 14°, range 33-84°) was corrected to 79° (SD 6°, range 70-90°). The median pre-operative rotation of 15° internal rotation was corrected to normal (0-15° of external rotation). Eight out of 25 limbs had severe deformities with varus or procurvatum greater than 40° or both. The mean pre-operative TFA of 28° varus (SD 13°, range 4-53°) was corrected to 1.8° valgus (SD 6°, range 14° varus to 13° valgus). The median follow-up was 19 months (range 6-67 months). The alignment after correction was "good" in 55% (11/20), "acceptable" in 35% (7/20) and "poor" in 10% (2/20).The median duration for correction was 16 days (IQR 11-31 days, range 7-71 days). The median number of prescribed correction programmes was 1 (IQR 1-2, range 1-5). The mean total time in the frame was 136 days (SD 34 days, range 85-201 days).All patients developed minor pin track infections that resolved with oral antibiotics (Category 1 complications). Four patients developed complications that necessitated modification of the treatment plan (Category 2 complications). In two cases, treatment objectives could not be achieved (Category 3 complications). Two patients treated before skeletal maturity developed recurrent genu varum.
Gradual correction with a computer-assisted hexapod external fixator may be a useful technique for correcting recurrent IBD or LOBD even in children with severe deformities. The results of gradual correction were similar in the two groups. While complications occur, most can be mitigated by timely intervention during the correction phase of treatment. Recurrence remains a concern if correction is performed before skeletal maturity.
Mare PH, Marais LC. Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease. Strategies Trauma Limb Reconstr 2022;17(1):32-37.
评估使用计算机辅助六足环形外固定器对患有布朗特病的儿童混合队列进行逐步矫正的矫正效果和并发症情况。
回顾性分析19例（25条肢体）患有复发性婴儿型（IBD）和晚发型布朗特病（LOBD）的儿童，采用六足外固定器逐步矫正的矫正情况和并发症。通过胫骨近端内侧角（MPTA）、胫骨近端后侧解剖角（aPPTA）和胫股解剖角（TFA）来测量矫正情况。76%（19/25）的病例存在肥胖。15条肢体被归类为婴儿型布朗特病，10条肢体为晚发型布朗特病。平均年龄为12.5岁（范围7 - 17岁）。
术前MPTA平均为59°（标准差13°，范围33 - 79°），矫正后平均为86°（标准差5°，范围77 - 93°）。术前aPPTA平均为64°（标准差14°，范围33 - 84°），矫正后为79°（标准差6°，范围70 - 90°）。术前15°内旋的中位数矫正为正常（外旋0 - 15°）。25条肢体中有8条存在严重畸形，内翻或前凸大于40°或两者皆有。术前TFA平均28°内翻（标准差13°，范围4 - 53°），矫正后为1.8°外翻（标准差6°，范围14°内翻至13°外翻）。中位随访时间为19个月（范围6 - 67个月）。矫正后的对线情况“良好”的占55%（11/20），“可接受”的占35%（7/20），“差”的占10%（2/20）。矫正的中位持续时间为16天（四分位间距11 - 31天，范围7 - 71天）。规定的矫正方案的中位数为1（四分位间距1 - 2，范围1 - 5）。在框架内的平均总时间为136天（标准差34天，范围85 - 201天）。所有患者均出现轻微的针道感染，经口服抗生素后缓解（1类并发症）。4例患者出现需要修改治疗方案的并发症（2类并发症）。2例患者未能达到治疗目标（3类并发症）。2例在骨骼成熟前接受治疗的患者出现复发性膝内翻。
即使对于严重畸形的儿童，使用计算机辅助六足外固定器进行逐步矫正可能是矫正复发性IBD或LOBD的一种有用技术。两组的逐步矫正结果相似。虽然会发生并发症，但大多数可以在治疗的矫正阶段通过及时干预得到缓解。如果在骨骼成熟前进行矫正，复发仍然是一个问题。
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Mare PH, Marais LC. Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease. Strategies Trauma Limb Reconstr 2022;17(1):32 - 37.
