Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Marienburgstraße 2, 60528, Frankfurt/Main, Germany.
Berufsgenossenschaftliche Unfallklinik Frankfurt/Main, Friedberger Landstraße 430, 60389, Frankfurt/Main, Germany.
Sci Rep. 2024 Jul 11;14(1):16060. doi: 10.1038/s41598-024-66169-9.
Predictors of rebound after correction of coronal plane deformities using temporary hemiepiphysiodesis (TH) are not well defined. The following research questions were tested: (1) Is the dynamic knee joint load useful to improve rebound prediction accuracy? (2) Does a large initial deformity play a critical role in rebound development? (3) Are BMI and a young age risk factors for rebound? Fifty children and adolescents with idiopathic knee valgus malalignment were included. A deviation of the mechanical femorotibial angle (MFA) of ≥ 3° into valgus between explantation and the one-year follow-up period was chosen to classify a rebound. A rebound was detected in 22 of the 50 patients (44%). Two predictors of rebound were identified: 1. reduced peak lateral knee joint contact force in the first half of the stance phase at the time of explantation (72.7% prediction); 2. minor initial deformity according to the MFA (70.5% prediction). The best prediction (75%) was obtained by including both parameters in the binary logistic regression method. A TH should not be advised in patients with a minor initial deformity of the leg axis. Dynamic knee joint loading using gait analysis and musculoskeletal modeling can be used to determine the optimum time to remove the plates.
使用临时骺板切除术（TH）矫正冠状面畸形后出现反弹的预测因素尚不清楚。本研究旨在测试以下三个问题：（1）动态膝关节负荷是否有助于提高反弹预测的准确性？（2）初始畸形程度是否对反弹的发展起着关键作用？（3）BMI 和年龄小是否是反弹的危险因素？本研究共纳入 50 例特发性膝内翻儿童和青少年。将机械股骨胫骨角（MFA）在取出和一年随访期间向外翻的差值≥3°作为反弹的分类标准。50 例患者中有 22 例（44%）出现反弹。确定了两个反弹的预测因素：1. 取板时，站立前期的外侧膝关节接触力峰值明显降低（预测准确率为 72.7%）；2. 根据 MFA，初始畸形较小（预测准确率为 70.5%）。通过将这两个参数纳入二元逻辑回归方法，可获得最佳的预测（75%）。对于下肢初始轴初始畸形较小的患者，不应建议进行 TH。使用步态分析和肌肉骨骼建模进行的动态膝关节负荷可以用来确定去除钢板的最佳时机。
