Zionts L E, Shean C J
Division of Pediatric Orthopaedics, Women's and Children's Hospital, Los Angeles, CA 90033, USA.
J Pediatr Orthop. 1998 Jan-Feb;18(1):102-9.
We reviewed 24 children (42 extremities) who had a diagnosis of early infantile tibia vara treated by using a brace. The indication for bracing was either a varus deformity that was not improving by age 18-24 months, or a persistent varus deformity seen in a patient older than 24 months. We prescribed an above-the-knee brace with a free ankle, single medial upright with valgus-producing straps, and either no hinged joint or a locked hinge joint at the knee. The braces were worn during the day and were removed for bedtime. The patients were followed up for an average of 27.2 months (range, 12-72) from the initiation of brace treatment, and the outcome at latest follow-up was determined by using radiographic criteria. Before treatment, 29 extremities were Langenskiöld stage I, II were stage II, and two were stage III. Before treatment, the metaphyseal-diaphyseal angle averaged 16.4 degrees. Forty of the 42 extremities had metaphyseal-diaphyseal angles of > 11 degrees, and 20 were > 16 degrees. Based on our criteria, we rated 29 extremities good, nine fair, and four poor. We conclude that daytime, ambulatory brace treatment may favorably alter the natural history of tibia vara in patients who are younger than 3 years and who have Langenskiöld stage I or II deformity.
我们回顾了24例诊断为早发性婴儿型胫骨内翻并接受支具治疗的儿童（42个肢体）。支具治疗的指征为18 - 24个月龄时内翻畸形仍未改善，或在24个月龄以上患者中出现的持续性内翻畸形。我们开具了一种带自由踝关节的膝上支具，单根内侧立柱并带有产生外翻的束带，膝关节处要么没有铰链关节，要么有锁定铰链关节。支具在白天佩戴，睡前取下。从开始支具治疗起，患者平均随访27.2个月（范围12 - 72个月），并使用影像学标准确定最近一次随访时的结果。治疗前，29个肢体为Langenskiöld I期，2个为II期，2个为III期。治疗前，干骺端 - 骨干角平均为16.4度。42个肢体中有40个干骺端 - 骨干角大于11度，20个大于16度。根据我们的标准，我们将29个肢体评为良好，9个评为中等，4个评为差。我们得出结论，对于3岁以下且有Langenskiöld I期或II期畸形的患者，日间行走支具治疗可能会有利地改变胫骨内翻的自然病程。
