Siemensma Mark F, van Bergen Christiaan J A, van Es Eline M, Colaris Joost W, Eygendaal Denise
Department of Orthopedics and Sports Medicine, Erasmus University Medical Center-Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands.
Department of Orthopaedic Surgery, Amphia Hospital, 4800 RK Breda, The Netherlands.
Children (Basel). 2023 Jan 20;10(2):195. doi: 10.3390/children10020195.
Osseous deformities in children arise due to progressive angular growth or complete physeal arrest. Clinical and radiological alignment measurements help to provide an impression of the deformity, which can be corrected using guided growth techniques. However, little is known about timing and techniques for the upper extremity. Treatment options for deformity correction include monitoring of the deformity, (hemi-)epiphysiodesis, physeal bar resection, and correction osteotomy. Treatment is dependent on the extent and location of the deformity, physeal involvement, presence of a physeal bar, patient age, and predicted length inequality at skeletal maturity. An accurate estimation of the projected limb or bone length inequality is crucial for optimal timing of the intervention. The Paley multiplier method remains the most accurate and simple method for calculating limb growth. While the multiplier method is accurate for calculating growth prior to the growth spurt, measuring peak height velocity (PHV) is superior to chronological age after the onset of the growth spurt. PHV is closely related to skeletal age in children. The Sauvegrain method of skeletal age assessment using elbow radiographs is possibly a simpler and more reliable method than the method by Greulich and Pyle using hand radiographs. PHV-derived multipliers need to be developed for the Sauvegrain method for a more accurate calculation of limb growth during the growth spurt. This paper provides a review of the current literature on the clinical and radiological evaluation of normal upper extremity alignment and aims to provide state-of-the-art directions on deformity evaluation, treatment options, and optimal timing of these options during growth.
儿童骨畸形是由于渐进性角状生长或完全骺板阻滞引起的。临床和放射学对线测量有助于了解畸形情况，可通过引导生长技术进行矫正。然而，关于上肢畸形矫正的时机和技术，人们了解甚少。畸形矫正的治疗选择包括畸形监测、（半）骺骨干固定术、骺板骨桥切除术和矫正截骨术。治疗取决于畸形的程度和部位、骺板受累情况、骺板骨桥的存在、患者年龄以及骨骼成熟时预计的肢体长度差异。准确估计预计的肢体或骨长度差异对于确定最佳干预时机至关重要。佩利乘数法仍然是计算肢体生长最准确、最简单的方法。虽然乘数法在计算生长突增前的生长时很准确，但在生长突增开始后，测量身高生长峰值速度（PHV）比按年龄计算更具优势。儿童的PHV与骨龄密切相关。使用肘部X线片评估骨龄的索韦格兰方法可能比使用手部X线片的格罗利希和派尔方法更简单、更可靠。需要为索韦格兰方法开发基于PHV的乘数，以便更准确地计算生长突增期间的肢体生长。本文综述了目前关于正常上肢对线的临床和放射学评估的文献，旨在为畸形评估、治疗选择以及生长过程中这些选择的最佳时机提供最新指导。
