Xiao Han,Zhu Guanghui,Mei Haibo,et al.Evaluations of hemiepiphysiodesis for proximal tibial valgus after initial union of congenital pseudarthrosis of the tibia in children[J].Journal of Clinical Pediatric Surgery,,21():1141-1146.[doi:10.3760/cma.j.cn101785-202204026-008]
Evaluations of hemiepiphysiodesis for proximal tibial valgus after initial union of congenital pseudarthrosis of the tibia in children
- Keywords:
- Tibia; Pseudarthrosis; Orthopedic Procedures; Treatment Outcome; Child
- Abstract:
- Objective To evaluate the clinical efficacy of hemiepiphysiodesis by eight-plate for proximal tibial valgus after congenital pseudarthrosis of the tibia (CPT) healing in children.Methods From September 2012 to May 2018,clinical data were retrospectively reviewed for 18 children (18 lower extremities) with proximal tibial valgus deformity after healing of CPT undergoing hemiepiphysiodesis by eight-plate.All cases had primary healing of CPT.By measuring the full-length radiographies of both lower extremities and tibiofibular films pre-operation,implants removal and the last follow-up,femoral tibial angle (mechanical tibiofemoral angle,mTFA),distal femoral lateral angle (anatomic lateral distal femoral angle,aLDFA) and proximal tibial medial angle (anatomical medial proximal tibial angle,aMPTA)were statistically analyzed for evaluating the correction outcomes and rebound phenomenon.Retention time of internal fixation was also recorded and rate of deformity correction (°/month) calculated. Results There were 9 boys and 9 girls.The involved side was left (n=10) and right (n=8).The average operative age was (4.2±1.4) years,the total average follow-up time (73.4±18.5) months and the average follow-up time after internal fixation removal (46.0±16.8) months.All cases had satisfactory outcomes with an average correction rate of 1.26°/month.There were fat liquefaction of incision (n=1) and screw loosening (n=1).No infection,breakage of internal fixation,internal fixation failure or epiphyseal injury occurred.Preoperative mTFA,aLDFA and aMPTA was (14.8±3.6)°,(85.7±2.7)° and (100.8±3.1)° respectively.During internal fixation removal,the above measurements were (3.7±3.2)°,(83.5±2.9)?nd (85.3±3.5)°.While in the last follow-up,mTFA was (5.5±3.6)°,aLDFA (82.0±1.8)?nd aMPTA (88.7±1.6)°.The differences in mTFA,aLDFA and aMPTA were significant at three timepoints (P<0.05).The inter-group comparison indicated that difference in mTFA was statistically significant during internal fixation removal and pre-operation (P<0.01).However no statistically significance existed in mTFA during internal fixation removal and at the last follow-up (P>0.05).Significant difference existed in aLDFA changes during internal fixation removal and pre-operation (P<0.01).However,no significant difference existed in aLDFA changes during internal fixation removal and at the last follow-up (P>0.05).Significant difference existed in aMPTA during internal fixation removal,pre-operation and at the final follow-up (P<0.01).aMPTA normalized after implant removal,but rose at the last follow-up.Four cases (22.2%) showed rebound phenomenon. Conclusion Hemiepiphysiodesis by eight-plate for proximal tibial valgus after initial union of CPT tibia in children offers the advantages of fast correction rate,minimal injury and satisfactory correction outcomes.However,there is a possibility of deformity rebound.
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Memo
收稿日期:2022-4-8。
基金项目:湖南省临床医疗技术创新引导项目(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);国家临床重点专科建设项目-湖南省儿童医院小儿外科(湘卫医发[2022]2 号)
通讯作者:赵卫华,Email:zhaoweihua100@163.com;朱光辉,Email:zgh5650@163.com