PDF(Pubmed)
Abstract：
BACKGROUND: Hemi-epiphysiodesis is the mainstay of treatment for angular deformities at the knee in children with multiple hereditary exostosis (MHE). Upon deformity correction, the metaphyseal screw may be removed from the hemi-epiphysiodesis plate, the sleeper plate technique, with anticipated reimplantation of the metaphyseal screw should the original deformity recur. The aim of the present study is to compare the incidence of complications with the sleeper plate technique with complete plate removal in an MHE cohort.
METHODS: Patients under the age of 18 with MHE who underwent hemi-epiphysiodesis of the proximal tibia and/or distal femur between February 1, 2016, and February 6, 2022 with a minimum 2-year follow-up or follow-up to skeletal maturity were identified via ICD-10 codes. Patient charts and radiographic images were reviewed to assess for the bone(s) treated, the use of sleeper plates, and whether any complication occurred, including overcorrection from bony ingrowth at the empty holes or deformity recurrence.
RESULTS: In 13 patients, 19 knees underwent hemi-epiphysiodesis at 30 sites; 13 distal femoral and 17 proximal tibial. Of 30 plates, 18 (60%) were removed completely upon deformity correction and 3 (10%) did not require removal due to skeletal maturity. Four of 13 (30.8%) femoral plates and 5 of 17 (29.4%) tibial plates were left as sleeper plates. All 5 tibial sleeper plates developed bony ingrowth into the empty metaphyseal screw hole, which led to unintended progressive deformity overcorrection. In the majority of cases, the deformity was addressed by the removal of the plate and exophytic bone and hemi-epiphysiodesis on the other side of the affected proximal tibia with subsequent resolution of the deformity.
CONCLUSIONS: All tibial sleeper plates developed bony ingrowth into the screwless metaphyseal hole. The bony ingrowth functioned as a tether, resulting in progressive deformity overcorrection. Sleeper plates should be avoided at the proximal tibia in patients with MHE, and extreme caution should be exercised when considering this technique at the distal femur or other sites.
METHODS: Level III-retrospective comparative study.
METHODS: Patients under the age of 18 with MHE who underwent hemi-epiphysiodesis of the proximal tibia and/or distal femur between February 1, 2016, and February 6, 2022 with a minimum 2-year follow-up or follow-up to skeletal maturity were identified via ICD-10 codes. Patient charts and radiographic images were reviewed to assess for the bone(s) treated, the use of sleeper plates, and whether any complication occurred, including overcorrection from bony ingrowth at the empty holes or deformity recurrence.
RESULTS: In 13 patients, 19 knees underwent hemi-epiphysiodesis at 30 sites; 13 distal femoral and 17 proximal tibial. Of 30 plates, 18 (60%) were removed completely upon deformity correction and 3 (10%) did not require removal due to skeletal maturity. Four of 13 (30.8%) femoral plates and 5 of 17 (29.4%) tibial plates were left as sleeper plates. All 5 tibial sleeper plates developed bony ingrowth into the empty metaphyseal screw hole, which led to unintended progressive deformity overcorrection. In the majority of cases, the deformity was addressed by the removal of the plate and exophytic bone and hemi-epiphysiodesis on the other side of the affected proximal tibia with subsequent resolution of the deformity.
CONCLUSIONS: All tibial sleeper plates developed bony ingrowth into the screwless metaphyseal hole. The bony ingrowth functioned as a tether, resulting in progressive deformity overcorrection. Sleeper plates should be avoided at the proximal tibia in patients with MHE, and extreme caution should be exercised when considering this technique at the distal femur or other sites.
METHODS: Level III-retrospective comparative study.
摘要：
背景：半表皮固定术是多发性遗传性外生体（MHE）儿童膝关节角畸形的主要治疗方法。在畸形矫正后，干phy端螺钉可从半表皮固定术板上移除，卧铺板技术，如果原始畸形复发，则预期会重新植入干phy端螺钉。本研究的目的是比较MHE队列中使用卧铺钢板技术和完全去除钢板的并发症发生率。
方法：在2016年2月1日至2022年2月6日之间进行胫骨近端和/或股骨远端半上皮固定术的18岁以下MHE患者通过ICD-10代码确定了至少2年的随访或对骨骼成熟度的随访。检查患者图表和放射摄影图像，以评估所治疗的骨，使用卧铺板，以及是否发生任何并发症，包括空洞骨向内生长过度矫正或畸形复发。
结果：在13例患者中，在30个部位进行了19个膝盖的半上皮固定术；股骨远端13个，胫骨近端17个。在30个盘子里，畸形矫正后，18（60％）被完全去除，而3（10％）由于骨骼成熟而不需要去除。留下13个股骨钢板中的4个（30.8％）和17个胫骨钢板中的5个（29.4％）作为卧铺钢板。所有5个胫骨枕板都向内生长到空的干骨干端螺钉孔中，导致意外的进行性畸形过度矫正。在大多数情况下,通过切除受影响的胫骨近端另一侧的钢板和外生骨和半表皮固定术解决了畸形，随后解决了畸形。
结论：所有胫骨枕板均向无螺钉干末端孔发展骨向内生长。骨向内生长起到系绳的作用，导致进行性畸形过度矫正。MHE患者胫骨近端应避免使用枕板，并且在股骨远端或其他部位考虑该技术时应格外小心。
方法：III级回顾性比较研究。
方法：在2016年2月1日至2022年2月6日之间进行胫骨近端和/或股骨远端半上皮固定术的18岁以下MHE患者通过ICD-10代码确定了至少2年的随访或对骨骼成熟度的随访。检查患者图表和放射摄影图像，以评估所治疗的骨，使用卧铺板，以及是否发生任何并发症，包括空洞骨向内生长过度矫正或畸形复发。
结果：在13例患者中，在30个部位进行了19个膝盖的半上皮固定术；股骨远端13个，胫骨近端17个。在30个盘子里，畸形矫正后，18（60％）被完全去除，而3（10％）由于骨骼成熟而不需要去除。留下13个股骨钢板中的4个（30.8％）和17个胫骨钢板中的5个（29.4％）作为卧铺钢板。所有5个胫骨枕板都向内生长到空的干骨干端螺钉孔中，导致意外的进行性畸形过度矫正。在大多数情况下,通过切除受影响的胫骨近端另一侧的钢板和外生骨和半表皮固定术解决了畸形，随后解决了畸形。
结论：所有胫骨枕板均向无螺钉干末端孔发展骨向内生长。骨向内生长起到系绳的作用，导致进行性畸形过度矫正。MHE患者胫骨近端应避免使用枕板，并且在股骨远端或其他部位考虑该技术时应格外小心。
方法：III级回顾性比较研究。
