Kurniawan Aryadi, Luthfi Omar, Pangestu Juniarto Jaya, Hutami Witantra Dhamar
Consultant Pediatric Orthopaedic Surgeon, Department of Orthopedic & Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta, 10430, Indonesia.
Department of Orthopedic & Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta, 10430, Indonesia.
Int Orthop. 2025 Mar;49(3):671-680. doi: 10.1007/s00264-025-06427-1. Epub 2025 Feb 13.
This is a preliminary study with short-term follow up to determine the safety and efficacy of the S-design osteotomy and internal fixation for acute varus and rotational correction technique in infantile Blount's disease.
We performed a retrospective series in our institutional hospital. An S-design osteotomy for multiplanar, acute correction followed by internal fixation was performed for Blount's disease patients. Effectiveness was measured by comparing pre-and post-operative tibiofemoral angle (TFA) and metaphyseal-diaphyseal angle (MDA). Safety was determined by the number of neurological deficits and compartment syndromes occurred post operatively. Functional outcome was assessed using the Lower Extremity Functional Scale (LEFS). All patients underwent a one-year follow-up after surgery.
Nineteen patients (total of 31 extremities) were included in this study and classified into TFA less than 40 degree (group A) and more than 40 degree (group B). No neurological deficits nor compartment syndrome occured in either group. Regardless the severity of pre-operative deformity, both groups achieved significant corrections. Post operatively there was no significant difference in TFA in Group A and Group B (1.70 and 3.00 respectively, with p value of 0.147) and MDA (4,60 and 6,0 respectively, with p value of 0.327). This indicated there was no correlation between preoperative deformity and postoperative results. LEFS score of group A (73.85 ± 2.73) and Group B (73.85 ± 2.73) showed equally good results in both groups (p = 0.293).
This preliminary study with short-term follow up suggested that the S-design osteotomy effectively corrected internal rotation and varus while aiding limb length. The correction of internal rotation is accomodated by performing box osteotomy between the two horizontal (proximal and distal) lines of osteotomy, with safe and effective results. Acute correction is a safe and effective strategy for severe Blount's disease. Longer-term follow-up is awaited.
V.
这是一项短期随访的初步研究，旨在确定S形截骨术及内固定用于婴儿型布朗特病急性内翻和旋转矫正技术的安全性和有效性。
我们在本院进行了一项回顾性研究。对布朗特病患者实施多平面急性矫正的S形截骨术，随后进行内固定。通过比较术前和术后的胫股角（TFA）和干骺端-骨干角（MDA）来衡量有效性。通过术后出现神经功能缺损和骨筋膜室综合征的数量来确定安全性。使用下肢功能量表（LEFS）评估功能结果。所有患者术后均接受了一年的随访。
本研究纳入了19例患者（共31个肢体），分为TFA小于40度组（A组）和大于40度组（B组）。两组均未出现神经功能缺损或骨筋膜室综合征。无论术前畸形的严重程度如何，两组均实现了显著矫正。术后A组和B组的TFA（分别为1.70和3.00，p值为0.147）和MDA（分别为4.60和6.0，p值为0.327）均无显著差异。这表明术前畸形与术后结果之间没有相关性。A组（73.85±2.73）和B组（73.85±2.73）的LEFS评分在两组中显示出同样良好的结果（p = 0.293）。
这项短期随访的初步研究表明，S形截骨术能有效矫正内旋和内翻，同时有助于肢体长度。通过在两条水平（近端和远端）截骨线之间进行盒状截骨来实现内旋的矫正，结果安全有效。急性矫正对于重度布朗特病是一种安全有效的策略。有待进行长期随访。
V级
