Li Anping,Hu Xiongke,Zhao Weihua,et al.Clinical study on the hemiepiphyseal treatment for postoperative ankle valgus in children with congenital pseudarthrosis of the tibia[J].Journal of Clinical Pediatric Surgery,,20():1149-1153.[doi:10.12260/lcxewkzz.2021.12.009]
Clinical study on the hemiepiphyseal treatment for postoperative ankle valgus in children with congenital pseudarthrosis of the tibia
- Keywords:
- Congenital Pseudarthrosis of The Tibia; Ankle Valgus; Growth Guidance Technique; Transphyseal Malleolar Screw; U-shaped Screw; Hemiepiphyseal; Treatment Outcome
- CLC:
- R726.834.23;R726.847.7
- Abstract:
- Objective A retrospective analysis of the clinical efficacy and safety of hemiepiphyseal with transphyseal malleolar screw and U-shaped screw in the treatment of ankle valgus after operation of congenital pseudarthrosis of the tibia (CPT).Methods A total of 44 patients with postoperative ankle valgus after CPT operation from May 2011 to Oct 2019 were included.18 patients were treated with transphyseal malleolar screw and 26 patients were treated with "U"-shaped screw, and the evaluation index was the lateral distal tibia angle.The general data, and preoperative, postoperative and final follow-up radiological data were recorded, and the deformity correction rate and complications were compared.Results All the patients were followed up for at least 13 months (35 months on average) after operation.In the transphyseal malleolar screw group, the preoperative lateral distal tibia angle was (74.4±6.3)°, and the lateral distal tibia angle was (87.6±3.4)° when the internal fixation was removed;in the U-shaped screw group, the preoperative lateral distal tibia angle was (73.9±5.1)°, and the lateral distal tibia angle was (88.4±3.5)° when the internal fixation was removed.The effect of deformity correction in the U-shaped screw group was better than that in transphyseal malleolar screw group, but the difference was not significant (P>0.05).Complications of internal fixation occurred in 2 cases in the transphyseal malleolar screw group, presenting as difficulty in removing the screws due to sinking into the bone.No internal fixation failure or wound infection occurred in all patients.Conclusion Transphyseal malleolar screw and "U"-shaped screw both can effectively correct the postoperative ankle valgus CPT operation through hemiepiphyseal, but the U-shaped screw method has relatively better corrective effects and lower incidence of complications.
References:
1 Paley D.Congenital Pseudarthrosis of the Tibia:Biological and Biomechanical Considerations to Achieve Union and Prevent Refracture[J].J Child Orthop, 2019, 13(2):120-133.DOI:10.1302/1863-2548.13.180147.
2 Nithin K, Kheireldin RK, Lu A, et al.Current treatment of congenital pseudarthrosis of the tibia:A systematic review and meta-analysis[J].J Pediatr Orthop B, 2018, 27(6):541-550.DOI:10.1097/BPB.0000000000000524.
3 Pannier S.Congenital Pseudarthrosis of the Tibia[J].Orthop Traumatol Surg Res, 2011, 97(7):750-761.DOI:10.1097/BPB.0000000000000524.
4 Thabet AM, Paley D, Kocaoglu M, et al.Periosteal grafting for congenital pseudarthrosis of the tibia:a preliminary report[J].Clin Orthop Relat Res, 2008, 466(12):2981-2994.DOI:10.1007/s11999-008-0556-1.
5 Zhu GH, Mei HB, He RG, et al.Combination of Intramedullary Rod, Wrapping Bone Grafting and Ilizarov’s Fixator for the Treatment of Crawford type IV Congenital Pseudarthrosis of the Tibia:Mid-term Follow up of 56 cases[J].BMC Musculoskelet Disord, 2016, 17(1):443.DOI:10.1186/s12891-016-1295-1.
6 Gibson V, Prieskorn D.The Valgus Ankle[J].Foot Ankle Clin, 2007, 12(1):15-27.DOI:10.1016/j.fcl.2006.11.001.
7 Chang FM, Ma J, Pan Z, et al.Rate of Correction and Recurrence of Ankle Valgus in Children Using a Transphyseal Medial Malleolar Screw[J].J Pediatr Orthop, 2015, 35(6):589-592.DOI:10.1097/BPO.0000000000000333.
8 Davids JR.The Foot and Ankle in Cerebral Palsy[J].Orthop Clin North Am, 2010, 41(4):579-593.DOI:10.1016/j.ocl.2010.06.002.
9 Payman KR, Patenall V, Borden P, et al.Complications of Tibial Osteotomies in Children with Comorbidities[J].J Pediatr Orthop, 2002, 22(5):642-644.DOI:10.1097/01241398-200209000-0001.
10 Burghardt RD, Herzenberg JE, Standard SC, et al.Temporary Hemiepiphyseal Arrest using a Screw and Plate Device to Treat Knee and Ankle Deformities in Children:a Preliminary Report[J].J Child Orthop, 2008, 2(3):187-197.DOI:10.1007/s11832-008-0096-y.
11 Westberry DE, Carpenter AM, Thomas JT, et al.Guided Growth for Ankle Valgus Deformity:The Challenges of Hardware Removal[J].J Pediatr Orthop, 2020, 40(9):e883-e888.DOI:10.1097/BPO.0000000000001583.
12 Oosterbos MV, Zwan A, Woude H, et al.Correction of ankle valgus by hemiepiphysiodesis using the tension band principle in patients with multiple hereditary exostosis[J].J Child Orthop, 2016, 10(3):267-273.DOI:10.1007/s11832-016-0742-8.
13 Borzunov DY, Chevardin AY, Mitrofanov AI.Management of Congenital Pseudarthrosis of the Tibia with the Ilizarov Method in a Paediatric Population:Influence of Aetiological Factors[J].Int Orthop, 2016, 40(2):331-339.DOI:10.1007/s00264-015-3029-7.
14 Liu YX, Mei HB, Zhu GH, et al.Congenital Pseudarthrosis of the Tibia in Children:Should We Defer Surgery Until 3 years old?[J].J Pediatr Orthop B, 2017, 27(1):17-25.DOI:10.1097/BPB.0000000000000468.
15 Agashe MV, Song SH, Refai MA, et al.Congenital Pseudarthrosis of the Tibia Treated with a Combination of Ilizarov’s Technique and Intramedullary Rodding[J].Acta Orthop, 2012, 83(5):515-522.DOI:10.3109/17453674.2012.736170.
16 Aurégan JC, Finidori G, Cadilhac C, et al.Children ankle valgus deformity treatment using a transphyseal medial malleolar screw[J].Orthop Traumatol Surg Res, 2011, 97(4):406-409.DOI:10.1016/j.otsr.2011.01.014.
17 Martínez G, Gündel A, Ruiz P, et al.Distal femoral hemiepiphysiodesis with screws and suture versus 8-plate for the treatment of genu valgum in children[J].Orthop Traumatol Surg Res, 2019, 105(4):751-755.DOI:10.1016/j.otsr.2019.02.019.
18 Zajonz D, Schumann E, Wojan M, et al.Treatment of genu valgum in children by means of temporary hemiepiphysiodesis using eight-plates:short-term findings[J].BMC Musculoskeletal Disord, 2017, 18(1):456.DOI:10.1186/s12891-017-1823-7.
19 Stevens PM, Kennedy JM, Hung M.Guided Growth for Ankle Valgus[J].J Pediatr Orthop, 2011, 31(8):878-883.DOI:10.1097/BPO.0b013e318236b1df.
20 Driscoll MD, Linton J, Sullivan E, et al.Medial Malleolar Screw Versus Tension-band Plate Hemiepiphysiodesis for Ankle Valgus in the Skeletally Immature[J].J Pediatr Orthop, 2013, 34(4):441-446.DOI:10.1097/BPO.0000000000000116.
21 Mielke CH, Stevens PM.Hemiepiphyseal Stapling for Knee Deformities in Children Younger than 10 years:a Preliminary Report[J].J Pediatr Orthop, 1996, 16(4):423-429.DOI:10.1097/00004694-199607000-00002.
Memo
收稿日期:2020-10-29。
基金项目:湖南省重点研发计划（编号：2020SK2113）；湖南省临床医疗技术创新引导项目（编号：2020SK50518）；湖南省发展和改革委员会创新研发项目（湘发改投资[2019]875号）
通讯作者:梅海波,Email:meihaibo@sina.com