Hussein Mohamed Abdelaal, Alsayed Mokhtar Ahmed, Al-Yami Ali H, Alakkas Eyad A, Althaqafi Raad M M, Aljahdali Ahmed, Hosny Gamal Ahmed, Khalifa Ahmed A
Orthopaedic Department, National Institute of Neuromotor System, Giza, Egypt.
Department of Orthopedic Surgery, Alhelal Hospital, Cairo, Egypt.
J Orthop Surg Res. 2025 Sep 17;20(1):821. doi: 10.1186/s13018-025-05829-6.
Correcting severe deformities associated with advanced stages of Blount's disease in adolescents varies in the literature between acute and gradual corrections. We aimed to report the early results (radiological and complications) of performing acute medial tibial plateau elevation combined with gradually correcting the metaphyseal deformity using an Illizarov external fixator in adolescents with late-presenting infantile Langenskiold stage V and VI Blount's disease.
A prospective case series of 24 patients (24 limbs) with Langenskiold stage V and VI Blount's disease having a mean age of 11.63 ± 1.74 years were included. The radiological outcomes included hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), Posterior proximal tibial angle (PPTA), and medial tibial plateau depression angle (MTPDA). Complications at any time point were reported.
The Illizarov frame was removed after a mean of 14 ± 2.04 weeks postoperatively. After a mean follow up of 23.33 ± 9.43 months, all the radiological outcomes improved significantly (< 0.001) compared to preoperative values, HKA: 182.17 ± 1.97 vs. 148.29 ± 9.88, MPTA:88.0 (87.0-90.0) vs. 75.5 (70.0-80.0), PPTA 82.0 ± 1.82 vs. 67.67 ± 5.02, JLCA: 2.46 ± 1.77 vs. 19.92 ± 2.75, and MTPDA: 1.96 ± 2.07 vs. 50.08 ± 7.19. No cases of neurovascular complications. The pin tract infection rate was 62.5%, and all were treated conservatively. Varus deformity recurred in 5 (20.8%) patients, all at the metaphyseal level, with no collapse at the elevated medial tibial plateau. Significant Leg length discrepancy (> 2 cm) was encountered in 6 (25%) patients (five were patients with recurrent varus deformities, where the LLD was compensated after deformity correction).
The management protocol we adopted, which entailed acute elevation of the medial tibial plateau depression combined with gradual correction of the proximal tibial deformity assisted by the Illizarov external fixator, provided promising results regarding its safety, ability of full deformity correction, and acceptable recurrence incidence.
Not applicable.
在青少年Blount病晚期相关严重畸形的矫正方面，文献中对于急性矫正和逐步矫正存在差异。我们旨在报告在婴儿型Langenskiold V期和VI期Blount病晚期的青少年中，采用急性胫骨内侧平台抬高联合使用伊里扎洛夫外固定器逐步矫正干骺端畸形的早期结果（影像学和并发症情况）。
纳入24例（24条肢体）Langenskiold V期和VI期Blount病患者的前瞻性病例系列，平均年龄11.63±1.74岁。影像学结果包括髋-膝-踝（HKA）角、胫骨近端内侧角（MPTA）、关节线汇聚角（JLCA）、胫骨近端后侧角（PPTA）和胫骨内侧平台凹陷角（MTPDA）。报告任何时间点的并发症情况。
术后平均14±2.04周拆除伊里扎洛夫框架。平均随访23.33±9.43个月后，与术前值相比，所有影像学结果均有显著改善（<0.001），HKA：182.17±1.97对比148.29±9.88，MPTA：88.0（87.0 - 90.0）对比75.5（70.0 - 80.0），PPTA 82.0±1.82对比67.67±5.02，JLCA：2.46±1.77对比19.92±2.75，MTPDA：1.96±2.07对比50.08±7.19。无神经血管并发症病例。针道感染率为62.5%，均采用保守治疗。5例（20.8%）患者出现内翻畸形复发，均发生在干骺端水平，抬高的胫骨内侧平台无塌陷。6例（25%）患者出现明显的下肢长度差异（>2cm）（5例为内翻畸形复发患者，畸形矫正后下肢长度差异得到代偿）。
我们采用的治疗方案，即急性抬高胫骨内侧平台凹陷并在伊里扎洛夫外固定器辅助下逐步矫正胫骨近端畸形，在安全性、完全矫正畸形的能力以及可接受的复发率方面取得了有前景的结果。
不适用。
