Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, South Korea.
Division of Pediatric Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea.
BMC Musculoskelet Disord. 2022 Dec 3;23(1):1052. doi: 10.1186/s12891-022-05996-1.
Percutaneous epiphysiodesis using a transphyseal screw (PETS) or tension-band plating (TBP) has shown favourable correction results; however, the physeal behaviours in terms of rebound, stable correction, or overcorrection after guided growth have not been completely understood. In patients with idiopathic genu valgum, we therefore asked: (1) How is the correction maintained after implant removal of guided growth? (2) Is there any difference in the natural behaviours after PETS or TBP removal at the femur and tibia?
We retrospectively reviewed 73 skeletally immature limbs with idiopathic genu valgum treated with PETS or TBP. PETS was performed in 23 distal femurs and 13 proximal tibias, and TBP was performed in 27 distal femurs and ten proximal tibias. Mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle were measured at pre-correction, implant removal, and final follow-up. Changes of ≤ 3° in mechanical angles after implant removal were considered stable. Comparisons between the implant, anatomical site, and existence of rebound were performed.
The mean MAD improved from - 18.8 mm to 11.3 mm at implant removal and decreased to -0.2 mm at the final follow-up. At the final follow-up, 39 limbs (53.4%) remained stable and only 12 (16.4%) were overcorrected. However, 22 limbs (30.1%) showed rebound. TBP was more common, and the correction period was longer in the rebound group (p < 0.001 and 0.013, respectively). In femurs treated with PETS, the mean mLDFA increased from 86.9° at implant removal to 88.4° at the final follow-up (p = 0.031), demonstrating overcorrection. However, a significant rebound from 89.7° to 87.1° was noted at the femur in the TBP group (p < 0.001). The correction of the proximal tibia did not change after implant removal.
The rebound was more common than overcorrection after guided growth; however, approximately half the cases demonstrated stable correction. The overcorrection occurred after PETS in the distal femur, while cases with TBP had a higher probability of rebound. The proximal tibia was stable after implant removal. The subsequent physeal behaviours after each implant removal should be considered in the guided growth.
经皮骺板内固定术（Percutaneous epiphysiodesis using a transphyseal screw，PETS）或张力带钢板固定（Tension-band plating，TBP）在矫正方面已取得良好效果；然而，骺板在引导生长后的反弹、稳定矫正或过度矫正等方面的行为仍未被完全理解。在特发性膝内翻患者中，我们因此提出以下问题：（1）引导生长后植入物去除后如何维持矫正效果？（2）在股骨和胫骨中，PETS 与 TBP 去除后的自然行为是否存在差异？
我们回顾性分析了 73 例采用 PETS 或 TBP 治疗的特发性膝内翻未成熟骨骼肢体。在 23 个股骨远端和 13 个胫骨近端施行 PETS，在 27 个股骨远端和 10 个胫骨近端施行 TBP。在矫正前、植入物去除时和最终随访时测量机械轴偏差（mechanical axis deviation，MAD）、机械外侧远端股骨角（mechanical lateral distal femoral angle，mLDFA）和机械内侧近端胫骨角（mechanical medial proximal tibial angle）。植入物去除后机械角度的变化≤3°被认为是稳定的。对植入物、解剖部位和反弹的存在进行了比较。
MAD 从植入物去除时的-18.8mm 改善至 11.3mm，最终随访时降至-0.2mm。最终随访时，39 条肢体（53.4%）保持稳定，仅有 12 条肢体（16.4%）出现过度矫正。然而，22 条肢体（30.1%）出现反弹。TBP 更为常见，反弹组的矫正时间也更长（p<0.001 和 0.013）。在接受 PETS 治疗的股骨中，mLDFA 从植入物去除时的 86.9°增加到最终随访时的 88.4°（p=0.031），表现为过度矫正。然而，在 TBP 组中，股骨的反弹明显从 89.7°增加至 87.1°（p<0.001）。植入物去除后胫骨近端的矫正没有变化。
引导生长后，反弹比过度矫正更为常见；然而，大约一半的病例表现出稳定的矫正。股骨远端的 PETS 治疗后出现过度矫正，而 TBP 治疗的病例更有可能出现反弹。胫骨近端在植入物去除后保持稳定。在引导生长中应考虑每个植入物去除后的后续骺板行为。
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