Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Faculty of Medicine Universitas Indonesia, RS. Fatmawati Raya St. No. 4, South Jakarta, 12430, Indonesia.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):529-537. doi: 10.1007/s00590-023-03699-4. Epub 2023 Aug 29.
The treatment of infantile Blount's disease usually includes surgical correction, but high recurrence is still a problem regardless of the procedure. We conducted a cross-sectional study of severely neglected infantile Blount's disease treated with acute correction and simultaneous hemiepiphysiodesis of lateral proximal tibia physis. In this study, we aimed to observe the complication and recurrence.
This research is an analytical study with a cross-sectional design using retrospective data collection and total sampling. The subjects were patients with neglected infantile Blount's disease treated from 2018 to 2023 in our institution. Follow-up was conducted in 6, 12, 24, and 36 months.
A total of 25 legs from twenty patients were recorded. We observed three legs (12.0%) had recurrence. No neurovascular complications and infections were observed. All subjects had significant postoperative improvement of TFA (mean 6.8 ± 0.73 valgus), Drennan angle, MPTA, MTPD, JLCA, and ligamentous laxity grading (p < 0.001). Lower than 5° postoperative valgus overcorrections and preoperative physeal bar were significant factors in patients with recurrence (p = 0.020 and p = 0.010). There was no significant increase in leg-length discrepancy during follow-up (p = 0.052). There were no significant differences between age, BMI, preoperative TFA, pre- and postoperative Drennan angle, MPTA, MTPD, JLCA, Langenskiöld stages, and length of follow-up in patients with recurrence and not.
Acute correction with simultaneous hemiepiphysiodesis of lateral proximal tibia physis is an effective technique to prevent deformity recurrence in neglected infantile Blount's disease, provided that the postoperative TFA is more than 5° of valgus and no evidence of physeal bar in the preoperative radiograph.
婴儿期 Blount 病的治疗通常包括手术矫正，但无论采用何种手术方式，其高复发率仍是一个问题。我们对接受急性矫正和同时进行外侧胫骨近端骺板骺骨切开术的严重忽视性婴儿期 Blount 病进行了一项横断面研究。本研究旨在观察其并发症和复发情况。
这是一项分析性研究，采用回顾性数据收集和总体抽样的横断面设计。研究对象为 2018 年至 2023 年在我院接受治疗的忽视性婴儿期 Blount 病患者。随访时间为 6、12、24 和 36 个月。
共记录了 20 名患者的 25 条腿。我们观察到 3 条腿（12.0%）出现了复发。未观察到神经血管并发症和感染。所有患者的 TFA（平均 6.8±0.73 度外翻）、Drennan 角、MPTA、MTPD、JLCA 和韧带松弛分级均有显著的术后改善（p<0.001）。术后 5 度以下的外翻过度矫正和术前骺板条带是导致复发的显著因素（p=0.020 和 p=0.010）。随访期间下肢长度差异无显著增加（p=0.052）。复发患者与未复发患者的年龄、BMI、术前 TFA、术前和术后 Drennan 角、MPTA、MTPD、JLCA、Langenskiöld 分期和随访时间均无显著差异。
急性矫正和同时进行外侧胫骨近端骺板骺骨切开术是预防忽视性婴儿期 Blount 病畸形复发的有效方法，但术后 TFA 应大于 5 度外翻，且术前 X 线片无骺板条带。
