背景:下肢的角畸形会导致疼痛,步态紊乱,美容畸形和关节退变。在引入引导增长之前,这已成为广泛接受的治疗方法,用于治疗骨骼未成熟患者的膝盖周围的额平面角畸形,治疗包括订书钉,矫正截骨术或有角度的上皮骨固定术。引导生长调节使用张力带原理,治疗的目标是使下肢机械轴正常化,从而比以前的治疗降低发病率。为了评估此程序的成功,我们回顾了我们的结果,试图确定可能无法从此优雅程序中受益的患者。
方法:我们在儿科三级国家转诊中心对前瞻性收集的手术记录和诊断影像进行了回顾性回顾,以确定2007年至2023年所有因膝关节冠状面角畸形进行过引导生长手术的患者。我们注意到了病人的人口统计,诊断,围手术期经验和结果。随访所有患者直至骨骼成熟,直到他们的硬件被删除或至少2年。
结果:评估了136名患者的资格。在符合最终评估标准的282个接受治疗的膝盖中,有55个(19.5%)不成功。并发症很少,但包括感染和金属加工突出。不太可能成功的手术包括创伤后生长障碍(18.8%失败)或感染(40%),肿瘤(66.6%),粘多糖I型(15.7%),脊柱骨骨发育不良(25%)或布朗特病(60%)。特发性角畸形在引导生长的情况下显示出89.5%的成功率。
结论:在我们手中,当考虑所有诊断时,引导生长的成功率为80.5%.我们继续提倡使用引导生长作为四肢畸形的骨骼未成熟患者的成功治疗选择,但是在考虑将其用于某些患者组时应谨慎使用。
方法:三级,回顾性队列研究。
BACKGROUND: Angular deformity in the lower extremity can result in pain, gait disturbance, cosmetic deformity and joint degeneration. Up until the introduction of guided growth, which has since become the widely accepted treatment for frontal plane angular angular deformity around the knee in skeletally immature patients, treatment consisted of staples, corrective osteotomy or an angular epiphysiodesis. Guided growth modulation uses the tension band principle with the goal of treatment being to normalise the lower limb mechanical axis resulting in lower morbidity than previous treatments. In order to assess the success of this procedure we reviewed our results in an attempt to identify patients who may not benefit from this elegant procedure.
METHODS: We performed a retrospective review of prospectively collected surgical records and diagnostic imaging in our paediatric tertiary national referral centre to identify all patients who had guided growth surgery for coronal plane angular deformity of the knee from 2007 to 2023. We noted the patient demographics, diagnosis, peri-operative experience and outcome. All patients were followed until skeletal maturity, until their hardware was removed or at least 2 years.
RESULTS: Two hundred thirty-six patients were assessed for eligibility. Of the 282 treated knees which met the criteria for final assessment 55 (19.5%) were unsuccessful. Complications were few but included infection and metal-work prominence. Procedures that were less likely to be successfully included growth disturbances following trauma (18.8% failure) or infection (40%), tumour (66.6%), mucopolysaccharidoses type I (15.7%), spondyloepiphyseal dysplasia (25%) or Blount\'s disease (60%). Idiopathic angular deformity showed an 89.5% success rate with guided growth.
CONCLUSIONS: In our hands, guided growth had an 80.5% success rate when all diagnoses were considered. We continue to advocate the use of guided growth as a successful treatment option for skeletally immature patients with limb deformity however caution should be employed when considering its use in certain patient groups.
METHODS: Level III, retrospective cohort study.