PDF(Pubmed)
Abstract：
Predictors of rebound after correction of coronal plane deformities using temporary hemiepiphysiodesis (TH) are not well defined. The following research questions were tested: (1) Is the dynamic knee joint load useful to improve rebound prediction accuracy? (2) Does a large initial deformity play a critical role in rebound development? (3) Are BMI and a young age risk factors for rebound? Fifty children and adolescents with idiopathic knee valgus malalignment were included. A deviation of the mechanical femorotibial angle (MFA) of ≥ 3° into valgus between explantation and the one-year follow-up period was chosen to classify a rebound. A rebound was detected in 22 of the 50 patients (44%). Two predictors of rebound were identified: 1. reduced peak lateral knee joint contact force in the first half of the stance phase at the time of explantation (72.7% prediction); 2. minor initial deformity according to the MFA (70.5% prediction). The best prediction (75%) was obtained by including both parameters in the binary logistic regression method. A TH should not be advised in patients with a minor initial deformity of the leg axis. Dynamic knee joint loading using gait analysis and musculoskeletal modeling can be used to determine the optimum time to remove the plates.
摘要：
使用临时半表皮固定术（TH）校正冠状面畸形后反弹的预测因子尚未明确。测试了以下研究问题：（1）动态膝关节负荷对提高回弹预测准确性是否有用？（2）大的初始畸形在回弹发展中起关键作用吗？（3）BMI和年轻年龄是否有反弹的危险因素？包括50名特发性膝关节外翻畸形的儿童和青少年。选择在外植体和一年随访期之间，外翻的机械股腿角（MFA）偏差≥3°，以对反弹进行分类。在50例患者中，有22例（44%）出现反弹。确定了两个反弹的预测因子:1.外植体前半个站姿阶段外侧膝关节接触力峰值降低(预测值为72.7%);2.根据MFA的轻微初始畸形(70.5%预测)。通过在二元逻辑回归方法中包括两个参数，可以获得最佳预测（75％）。对于腿轴较小的初始畸形的患者，不应建议使用TH。使用步态分析和肌肉骨骼建模的动态膝关节负荷可用于确定移除板的最佳时间。
