Laufer Andrea, Frommer Adrien, Gosheger Georg, Toporowski Gregor, Rölfing Jan Duedal, Antfang Carina, Roedl Robert, Vogt Bjoern
Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, 48149 Muenster, Germany.
General Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Muenster, Germany.
J Clin Med. 2023 Apr 21;12(8):3022. doi: 10.3390/jcm12083022.
Leg length discrepancies (LLD) are frequently associated with coronal malalignment. Temporary hemiepiphysiodesis (HED) is a well-established procedure for the correction of limb malalignment in skeletally immature patients. For treatment of LLD > 2 cm, lengthening with intramedullary devices gains increasing popularity. However, no studies have investigated the combined application of HED and intramedullary lengthening in skeletally immature patients. This retrospective single-center study evaluated the clinical and radiological outcomes of femoral lengthening with an antegrade intramedullary lengthening nail combined with temporary HED performed in 25 patients (14 females) between 2014 and 2019. Temporary HED through the implantation of flexible staples of the distal femur and/or proximal tibia was either performed prior ( = 11), simultaneously ( = 10) or subsequently ( = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4). The median initial LLD was 39.0 mm (35.0-45.0). Twenty-one patients (84%) presented valgus and four (16%) showed varus malalignment. Leg length equalization was achieved in 13 of the skeletally mature patients (62%). The median LLD of the eight patients with residual LLD > 10 mm at skeletal maturity was 15.5 mm (12.8-21.8). Limb realignment was observed in nine of seventeen skeletally mature patients (53%) in the valgus group, and in one of four patients (25%) in the varus group. Combining antegrade femoral lengthening and temporary HED is a viable option to correct LLD and coronal limb malalignment in skeletally immature patients; however, achieving limb length equalization and realignment may be difficult in cases of severe LLD and angular deformity, in particular.
下肢长度差异（LLD）常与冠状面排列不齐相关。临时半骨骺阻滞术（HED）是一种成熟的用于矫正骨骼未成熟患者肢体排列不齐的手术。对于LLD>2 cm的治疗，髓内装置延长术越来越受欢迎。然而，尚无研究调查HED与髓内延长术在骨骼未成熟患者中的联合应用。这项回顾性单中心研究评估了2014年至2019年间25例患者（14例女性）采用顺行髓内延长钉联合临时HED进行股骨延长的临床和影像学结果。通过在股骨远端和/或胫骨近端植入弹性钉进行临时HED，在股骨延长术前（n = 11）、同时（n = 10）或之后（n = 4）进行。平均随访期为3.7年（±1.4）。初始LLD的中位数为39.0 mm（35.0 - 45.0）。21例患者（84%）表现为外翻，4例（16%）表现为内翻排列不齐。13例骨骼成熟患者（62%）实现了下肢长度均衡。8例骨骼成熟时残留LLD>10 mm的患者，LLD的中位数为15.5 mm（12.8 - 21.8））。外翻组17例骨骼成熟患者中有9例（53%）观察到肢体重新排列，内翻组4例患者中有1例（25%）观察到肢体重新排列。联合顺行股骨延长术和临时HED是矫正骨骼未成熟患者LLD和冠状面肢体排列不齐的可行选择；然而，特别是在严重LLD和角形畸形的情况下，实现肢体长度均衡和重新排列可能会很困难。
