经皮骨骺阻滞术：经骨骺螺钉与张力带钢板作为半骨骺阻滞术治疗膝关节冠状面角状畸形的比较：一项比较研究的系统评价和荟萃分析

Percutaneous epiphysiodesis transphyseal screw versus tension-band plating as hemiepiphysiodesis in treating coronal angular knee deformities: a systematic review and meta-analysis of comparative studies.

作者信息

Sabry Ahmed O, Genedy Mohamed K A, Abouelwafa Salma, Khalil Ahmed A, Mady Omar, Mostafa Noureldin, Elsayed Rana Ali Ahmed, Elbarbary Hassan, Hegazy Mohamed, Abdelgawad Amr

机构信息

Orthopaedic Department, Faculty of Medicine, Cairo University, El Saray Street Manial - El Manial, Cairo, 11956, Egypt.

Orthopaedic Research Network, Faculty of Medicine, Cairo University, Cairo, Egypt.

出版信息

BMC Musculoskelet Disord. 2025 Apr 11;26(1):355. doi: 10.1186/s12891-025-08540-z.

DOI:10.1186/s12891-025-08540-z

PMID:40217231

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11987184/

Abstract

BACKGROUND

Angular knee deformities such as genu varum and genu valgum are common in children and can impact their functional mobility and quality of life. Although surgical interventions like guided growth plates or tension-band plates (TBP) and percutaneous epiphysiodesis transphyseal screws (PETS) are commonly used, comparative analyses of their efficacy and safety are limited. This study aims to evaluate the correction rates and safety profiles of TBP and PETS in treating pediatric coronal angular knee deformities.

METHODS

A comprehensive literature search was conducted in Scopus, Web of Science, and PubMed until November 2024. Only comparative clinical studies comparing PETS and TBP in pediatric patients with coronal knee deformities were included.

RESULTS

A total of five studies encompassing 473 physes were included. Their methodological quality was assessed using the MINORS criteria, with scores ranging from 18 to 19, indicating a low risk of bias. PETS demonstrated significantly higher correction rates compared to TBP, with an overall pooled mean difference in angular correction of 0.17°/month (p < 0.0003). In the femoral subgroup analysis (LDFA), the mean difference correction rate was 0.21°/month in favor of PETS (p = 0.01). Additionally, the PETS group achieved a statistically significant mechanical axis deviation mean difference correction rate of 1.02 mm/month (p = 0.006). Complication rates were relatively lower with PETS across all included studies.

CONCLUSION

PETS achieves faster angular and mechanical axis deviation correction rates compared to TBP, highlighting its efficiency in treating pediatric coronal angular knee deformities. Additionally, PETS demonstrates relatively fewer complications, reinforcing its position as a more effective and cost-efficient option for guided growth in children.

CLINICAL TRIAL NUMBER

Not applicable.

LEVEL OF EVIDENCE

II.

摘要

背景

膝内翻和膝外翻等膝关节角畸形在儿童中很常见，会影响他们的功能活动能力和生活质量。尽管诸如引导生长板或张力带钢板（TBP）以及经皮骨骺阻滞术经骨骺螺钉（PETS）等手术干预措施被广泛使用，但对其疗效和安全性的比较分析却很有限。本研究旨在评估TBP和PETS治疗小儿冠状面膝关节角畸形的矫正率和安全性。

方法

截至2024年11月，在Scopus、科学网和PubMed上进行了全面的文献检索。仅纳入比较PETS和TBP治疗小儿冠状面膝关节畸形的比较临床研究。

结果

共纳入五项研究，涉及473个骨骺。使用MINORS标准评估其方法学质量，得分在18至19分之间，表明偏倚风险较低。与TBP相比，PETS的矫正率显著更高，角度矫正的总体合并平均差异为0.17°/月（p < 0.0003）。在股骨亚组分析（LDFA）中，有利于PETS的平均差异矫正率为0.21°/月（p = 0.01）。此外，PETS组在机械轴偏差平均差异矫正率方面达到了统计学显著水平，为1.02 mm/月（p = 0.006）。在所有纳入研究中，PETS的并发症发生率相对较低。