Carroll Kristen L, Stotts Alan K, Pearson Olivia C, MacWilliams Bruce A
Motion Analysis Center, Shriners Children's.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
J Pediatr Orthop. 2023 Mar 1;43(3):162-167. doi: 10.1097/BPO.0000000000002336. Epub 2023 Jan 9.
Guided growth is commonly used to treat frontal plane alignment deformities in skeletally immature individuals. Treatment aims are to correct the biomechanical loading of the knee and to avoid more invasive surgery that would be required after skeletal maturity. There is little published evidence of pain perception or functional limitations in this population. In addition, the intervention has the potential to worsen pain and function with hardware implantation, and symptoms may not fully resolve after removal. Understanding of pain and function limitations in this population is important to guide the clinical expectations.
Individuals with idiopathic knee genu valgum who underwent hemiepiphysiodesis with tension plate constructs were identified through a medical records database search. Patient-reported outcomes measurement information system Physical Function/Mobility and Pain Interference domain scores were assessed before hemiepiphysiodesis, immediately before hardware removal, and after hardware removal. Radiographs were also assessed at these times to record the zones and angles of deformity and correction.
Twenty-eight subjects (53 operative limbs) contributed to the analysis. Mobility and pain interference as measured by the patient-reported outcomes measurement information system were below typical values in a small percentage of the population studied, only 3.6% scored in the moderate and none in the severe categories for both domains. Valgus by radiographic zone was corrected in all patients without significant rebound at follow-up. Compared with preoperative levels, mobility scores improved before hardware removal. Pain Interference scores improved both before hardware removal and at the final follow-up.
Frontal plane knee deformities in the idiopathic population do not cause pain or limit mobility in most subjects. This is critical information, emphasizing that surgical decisions may be made based on the deformity alone, presence of symptoms, and possible future morbidity secondary to valgus deformity. If surgery is postponed because an individual is asymptomatic, the window for correction with guided growth may be lost. Individuals undergoing hemiepiphysiodesis can expect that their pain and function will not be worse during the time that hardware is in place and that surgery is likely to improve any pain they may be experiencing.
Level III; retrospective comparative study.
引导性生长常用于治疗骨骼未成熟个体的额状面排列畸形。治疗目的是纠正膝关节的生物力学负荷，并避免在骨骼成熟后需要进行的更具侵入性的手术。关于该人群疼痛感知或功能受限的已发表证据很少。此外，随着硬件植入，该干预措施有可能使疼痛和功能恶化，并且在移除硬件后症状可能无法完全缓解。了解该人群的疼痛和功能受限情况对于指导临床预期很重要。
通过病历数据库搜索，识别接受半骨骺阻滞术并使用张力板结构的特发性膝外翻个体。在半骨骺阻滞术前、即将移除硬件前以及移除硬件后，评估患者报告的结局测量信息系统的身体功能/活动能力和疼痛干扰领域得分。在这些时间点还评估了X线片，以记录畸形和矫正的区域及角度。
28名受试者（53个手术肢体）参与了分析。在研究的一小部分人群中，患者报告的结局测量信息系统所测量的活动能力和疼痛干扰低于典型值，两个领域中只有3.6%的人得分处于中度，无人得分处于重度。所有患者的X线片区域外翻均得到纠正，随访时无明显反弹。与术前水平相比，在移除硬件前活动能力得分有所改善。疼痛干扰得分在移除硬件前和最终随访时均有所改善。
特发性人群中的额状面膝关节畸形在大多数受试者中不会引起疼痛或限制活动能力。这是关键信息，强调手术决策可能仅基于畸形、症状的存在以及外翻畸形可能导致的未来发病率做出。如果因为个体无症状而推迟手术，可能会错过引导性生长矫正的时机。接受半骨骺阻滞术的个体可以预期，在硬件植入期间他们的疼痛和功能不会恶化，并且手术可能会改善他们可能正在经历的任何疼痛。
III级；回顾性比较研究。
