目的:本系统综述和荟萃分析的主要目的是评估3种不同的上皮固定技术在儿科人群中使用植入物治疗腿长差异(LLD)的成功率。次要目标是解决有效性(最终LLD)和报告的订书钉并发症,张力带板(TBP),和经皮表皮固定术螺钉(PETS)。
方法:在这篇系统综述中,我们搜索了MEDLINE(PubMed),Embase,科克伦图书馆,WebofScience和Scopus对骨骼未成熟的LLD患者进行了研究。所提取的结果类别是上生理固定术的有效性(LLD测量术前/术后,成功/不成功)和按严重程度分级的并发症。
结果:纳入44项研究(2,184例患者)。455接受了PETS的表皮固定术,578例TBP患者,和1,048个钉书钉。据报道,PETS(9项研究)成功的上皮外皮固定术占76%(95%置信区间[CI]61-89),67%(CI54-79)伴有TBP(10项研究),51%(CI28-65)患有布朗特订书钉(8项研究)。根据汇总分析,PETS的严重并发症发生率为7%,17%的TBP,布朗特主食为16%。据报道,PETS后有4%的人出现角畸形,TBP后10%,在布朗特主食之后还有17%。
结论:我们的研究结果表明,采用PETS植入物的上皮组织固定术是最成功的技术。PETS的成功率更高,更少的严重并发症,角畸形比例较低。
OBJECTIVE: The primary aim of this systematic review and meta-analysis was to evaluate the success rate of 3 different epiphysiodesis techniques with implant usage for the treatment of leg-length discrepancy (LLD) in the pediatric population. The secondary aim was to address effectiveness (final LLD) and the reported complications of staples, tension-band plates (TBP), and percutaneous epiphysiodesis screws (PETS).
METHODS: In this systematic review we searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with epiphysiodesis with an implant. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre-/postoperatively, successful/unsuccessful) and complications that were graded on severity.
RESULTS: 44 studies (2,184 patients) were included. 455 underwent epiphysiodesis with PETS, 578 patients with TBP, and 1,048 with staples. Successful epiphysiodesis was reported in 76% (95% confidence interval [CI] 61-89) with PETS (9 studies), 67% (CI 54-79) with TBP (10 studies), and 51% (CI 28-65) with Blount staples (8 studies). From pooled analysis, the severe complications rate was 7% for PETS, 17% for TBP, and 16% for Blount staples. Angular deformity was reported in 4% after PETS, 10% after TBP, and 17% after Blount staples.
CONCLUSIONS: Our results showed that epiphysiodesis with PETS implants was the most successful technique. PETS had a higher success rate, fewer severe complications, and a lower proportion with angular deformity.