From the Department of Cardiology, Mt. Sinai Health System, New York, NY (Hanstein), Department of Orthopaedic Surgery, Children's Hospital at Montefiore Medical Center, Bronx, NY (Schulz and Sharkey), Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Schneble and Socci), and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Lo).
J Am Acad Orthop Surg. 2024 Mar 1;32(5):e240-e250. doi: 10.5435/JAAOS-D-21-00515. Epub 2023 Oct 18.
Our understanding of the efficacy of guided growth surgery with tension-band plating (TBP) in early-onset Blount disease is evolving. Preliminary work has demonstrated that TBP can normalize the mechanical axis, yet its effect on Langenskiöld stage (LS) has not previously been reported. The primary outcome of this study was improvement in LS after TBP. Secondary outcomes were improvement in LS at most recent follow-up and improvement in mechanical axis deviation (MAD), mechanical medial proximal tibial angle, and mechanical lateral distal femoral angle at treatment completion and most recent follow-up.
A retrospective review was done of patients with early-onset Blount disease treated with TBP between January 1, 2010, and December 31, 2019, across two institutions. Inclusion criteria were a radiographic diagnosis of early-onset Blount disease (LS changes present), surgery with TBP, and follow-up beyond implant removal. Radiographs before surgery, at removal of hardware (ROH), and at most recent follow-up were evaluated.
Twenty-five limbs in 16 children who underwent TBP at a mean age of 5.8 ± 2.3 years were included. Implants were in situ a mean of 1.9 ± 0.7 years. The mean follow-up after ROH was 3.6 ± 1.4 years. LS ranged from 1 to 5 preoperatively with 14 of 25 limbs (56%) staged ≥3. LS improved in 15 of 25 limbs (60%) at ROH and in 21 of 25 limbs (84%) at most recent follow-up. Langenskiöld changes resolved in 7 of 25 limbs (28%) at most recent follow-up. Preoperatively, the MAD was varus in all limbs, but at ROH, the MAD had improved in 22 of 23 limbs with neutral or valgus alignment in 20 of 23 limbs (87%). At most recent follow-up, 16 of 23 limbs (70%) maintained improved alignment.
There was improvement/resolution of LS and varus deformity in early-onset Blount disease in most patients who underwent TBP. Based on these results, TBP for early-onset Blount disease should be the first-line surgical treatment.
IV.
我们对早期发病 Blount 病中引导生长手术联合张力带钢板（TBP）疗效的理解在不断发展。初步研究表明，TBP 可以使力学轴正常化，但它对 Langenskiöld 分期（LS）的影响以前尚未报道。本研究的主要结果是 TBP 后 LS 的改善。次要结果是 TBP 治疗完成和最近随访时 LS 的改善、LS 最近随访时的改善、机械轴偏差（MAD）、机械内侧近端胫骨角和机械外侧远端股骨角的改善。
对 2010 年 1 月 1 日至 2019 年 12 月 31 日期间在两家机构接受 TBP 治疗的早期发病 Blount 病患者进行了回顾性研究。纳入标准为：早期发病 Blount 病的放射学诊断（存在 LS 改变）、TBP 手术、植入物去除后随访。评估了手术前、去除硬件时（ROH）和最近随访时的 X 线片。
16 名儿童的 25 条肢体在平均年龄 5.8±2.3 岁时接受了 TBP 治疗。植入物在位时间平均为 1.9±0.7 年。ROH 后平均随访 3.6±1.4 年。ROH 时，25 条肢体中有 15 条（60%）LS 改善，25 条肢体中有 21 条（84%）LS 改善。最近随访时，25 条肢体中有 7 条（28%）LS 改变完全消退。术前所有肢体的 MAD 均为内翻，但 ROH 时，23 条肢体中有 22 条（87%）MAD 改善，23 条肢体中有 20 条（87%）为中立或外翻排列。最近随访时，23 条肢体中有 16 条（70%）保持了改善的排列。
在接受 TBP 的大多数早期发病 Blount 病患者中，LS 和内翻畸形均得到改善/缓解。基于这些结果，TBP 应该成为早期发病 Blount 病的一线治疗方法。
IV。
