Shriners Children's and University of Kentucky Department of Orthopaedic Surgery and Sports Medicine, Lexington, KY.
Shriner's Children's, Galveston, TX.
J Pediatr Orthop. 2022 Oct 1;42(9):488-495. doi: 10.1097/BPO.0000000000002238. Epub 2022 Aug 16.
Despite early osteotomy, many patients with infantile tibia vara (ITV) have persistent or recurrent varus deformity and disordered growth at the medial proximal tibial physis. Our hypothesis was that lateral tibial tension band plating (LTTBP) could guide correction.
A retrospective review at 6 centers of 15 patients (16 extremities) was performed of LTTBP for varus deformity following early osteotomy in ITV, diagnosed≤4years of age. Correction of deformity parameters on digital standing anteroposterior lower extremity radiographs determined outcome.
Twenty-two LTTBP procedures were performed at mean age of 7.5 years, including 4 revisions for implant failure and 2 reimplantations for recurrence. Single event LLTBP, improved the medial proximal tibial angle with a mean change of 13.4 degrees (0.39 degrees/month). Eleven limbs had preoperative mechanical lateral distal femoral angle (mLDFA)>90 degrees. While n degree femoral procedures were performed, at study end, 11 femurs had mechanical lateral distal femoral angle≤90°. Pretreatment, 13 extremities had mechanical axis zone (MAZone) III varus (81%) and 3 had MAZone II varus (19%). LTTBP's were able to initially correct 13 limbs to MAZone I or valgus but 4 limbs rebounded to MAZone II varus after implant removal. Final limb alignment, after all surgeries and rebound, included 9 in MAZone I, 5 in MAZone II varus and 2 in MAZone III varus. Average follow-up was 3.0 years at mean 10.7 years of age. Fifteen procedures resulted in improvement in MAZone and 7 had no change. On average, those that improved were younger (7.3 vs. 8.0 y), weighed less (45.5 kg with body mass index 26.5 kg/m 2 vs. 67.8 kg and body mass index 35.7 kg/m 2 ), had lower mechanical axis deviation (37.1 mm vs. 43.9 mm), lower medial physeal slope (61.7 vs. 68.7 degrees) and had a higher percentage of open triradiate phases (87 vs. 57%).
LTTBP for residual varus, after initial osteotomy in ITV, resulted in 81% of limbs initially achieving MAZone I or valgus with implant failure revisions and femoral remodeling. Rebound after implant removal reduced the corrected rate to 56%. Ninety-four percent avoided osteotomy during the study period.
IV.
尽管早期进行了截骨术，但许多患有婴儿型胫骨内翻（ITV）的患者仍存在持续性或复发性内翻畸形和内侧胫骨近端骺板生长紊乱。我们的假设是外侧胫骨张力带钢板固定（LTTBP）可以引导矫正。
对 6 个中心的 15 名（16 侧）年龄≤4 岁、早期截骨术后 ITV 出现内翻畸形的患者进行回顾性研究，均行 LTTBP 治疗。通过数字站立前后下肢 X 线片上的畸形参数校正来确定结果。
22 例 LTTBP 手术于平均 7.5 岁时进行，其中 4 例因植入物失败而进行了翻修，2 例因复发而重新植入。单次 LTTBP 手术可使内侧胫骨近端角平均改善 13.4 度（0.39 度/月）。11 个肢体术前机械性外侧股骨远端角（mLDFA）>90 度。虽然进行了 n 度股骨手术，但在研究结束时，11 个股骨的机械性外侧股骨远端角≤90°。治疗前，13 个肢体的机械轴区（MAZone）呈 III 度内翻（81%），3 个肢体呈 MAZone II 度内翻（19%）。LTTBP 最初可将 13 个肢体矫正至 MAZone I 或外翻，但 4 个肢体在植入物移除后反弹至 MAZone II 度内翻。所有手术和反弹后的最终肢体对线包括 9 例 MAZone I，5 例 MAZone II 度内翻和 2 例 MAZone III 度内翻。平均随访 3.0 年，平均年龄为 10.7 岁。15 例手术改善了 MAZone，7 例无变化。平均而言，改善的患者年龄较小（7.3 岁 vs. 8.0 岁），体重较轻（45.5kg，体重指数 26.5kg/m 2 ，体重 67.8kg，体重指数 35.7kg/m 2 ），机械轴偏差较小（37.1mm vs. 43.9mm），内侧骺板斜率较低（61.7 度 vs. 68.7 度），三辐射骨骺开放百分比较高（87% vs. 57%）。
ITV 初始截骨术后，外侧胫骨张力带钢板固定治疗残余内翻畸形，81%的肢体最初达到 MAZone I 或外翻，植入物失败和股骨重塑后出现翻修。植入物移除后的反弹使校正率降至 56%。在研究期间，94%的患者避免了截骨术。
IV。
