Xiao Baohui,Lei Ting,Zeng Lan,et al.Evaluation of short-term clinical efficacy of a novel U-nail semi-epiphyseal block for anterolateral tibial angulation deformity in children with type Ⅰ neurofibromatosis[J].Journal of Clinical Pediatric Surgery,,():258-261.[doi:10.3760/cma.j.cn101785-202310026-011]
Evaluation of short-term clinical efficacy of a novel U-nail semi-epiphyseal block for anterolateral tibial angulation deformity in children with type Ⅰ neurofibromatosis
- Abstract:
- Objective To evaluate short-term clinical efficacy of a novel U-nail semi-epiphyseal block for anterolateral tibial angulation deformity in children with type I neurofibromatosis (NF1).Methods From January 2018 to October 2021,retrospective analysis was performed for 15 children of anterolateral tibial angulation deformity with NF1 at Hunan Children’s Hospital.There were 10 boys and 5 girls.The involved side was left (n=12) and right (n=3).Differential length of bilateral tibia was measured on full-length radiographs of both lower extremities and preoperative tibiofibular radiographs and at removal time of internal fixation.The number of angles between proximal axis of tibial stem and distal axis of tibial stem (tibiofibular diaphysis angle) were measured.The complications of wound infection,loosening/breakage of internal fixation,tibial fracture,bone bridging of epiphyseal plate,poor wound healing and soft tissue agitation were observed.The effects of tibial angulation correction on frontal and lateral radiographs were examined through the differences in bilateral tibial length before and after surgery.Duration of internal fixation retention and rate of deformity correction (°/month) were recorded.Results Three cases developed concurrent fibular pseudoarthrosis.Operative age was (49.27±23.29) months.All corrections were satisfactory and duration of internal fixation was (24.13±7.26) months.Average correction rate of tibial angulation deformity was (0.77±0.09)°/month.In 1 case,loose U-nail cutting epiphyseal plate was replaced by another operation.However,there was no bone bridge formation.There was no occurrence of infection,internal fixation breakage,tibial fracture,epiphyseal plate bridge,poor wound healing,soft tissue irritation or other complications.Diaphysis angle in orthopantomogram was (29.72±6.87)° preoperatively and (10.58±3.79)° at time of internal fixation and the inter-group difference was significant (P<0.05).The difference between preoperative (17.95±9.56)° and internal fixation (14.29±5.49)° was insignificant (P>0.05).The difference in bilateral tibia length was (0.79±0.54) cm preoperatively and (1.39±1.91) cm postoperatively.And insignificant difference existed in bilateral tibia length between preoperative and postoperative periods (P>0.05).Conclusions Using a novel U-shaped for congenital anterolateral tibial angulation,hemiepiphysiodesis offers high correction rate,minimal injury,satisfactory outcomes and simple handling.It may prevent tibial fracture in children.However,long-term outcomes should be verified by further follow-ups.
References:
[1] 简书浪,梅海波.儿童先天性胫骨前外侧弯曲畸形治疗研究进展[J].中华小儿外科杂志,2023,44(5):458-463.DOI:10.3760/cma.j.cn421158-20220423-00283.Jian SL,Mei HB.Research therapeutic advances for anterolateral tibial bowing of in children[J].Chin J Ped Sur,2023,44(5):458-463.DOI:10.3760/cma.j.cn421158-20220423-00283.
[2] Soldado F,Barrera-Ochoa S,Romero-Larrauri P,et al.Congenital pseudarthrosis of the tibia:rate of and time to bone union following contralateral vascularized periosteal tibial graft transplantation[J].Microsurgery,2022,42(4):326-332.DOI:10.1002/micr.30868.
[3] Laine JC,Novotny SA,Weber EW,et al.Distal tibial guided growth for anterolateral bowing of the tibia:fracture May be prevented[J].J Bone Joint Surg Am,2020,102(23):2077-2086.DOI:10.2106/JBJS.20.00657.
[4] Siebert MJ,Makarewich CA.Anterolateral tibial bowing and congenital pseudoarthrosis of the tibia:current concept review and future directions[J].Curr Rev Musculoskelet Med,2022,15(6):438-446.DOI:10.1007/s12178-022-09779-y.
[5] El-Rosasy MAM,Hammad ME,Nada AA.Congenital segmental tibial dysplasia and late onset pseudarthrosis of the tibia[J].J Orthop,2022,32:25-30.DOI:10.1016/j.jor.2022.05.004.
[6] Al Kaissi A,Klaushofer K,Grill F,et al.Bilateral and symmetrical anteromedial bowing of the lower limbs in a patient with neurofibromatosis type-Ⅰ[J].Case Rep Orthop,2015,2015:425970.DOI:10.1155/2015/425970.
[7] Banchhor H,Chimurkar V.Congenital pseudoarthrosis of the tibia:a narrative review[J].Cureus,2022,14(12):e32501.DOI:10.7759/cureus.32501.
[8] Vander Have KL,Hensinger RN,Caird M,et al.Congenital pseu-darthrosis of the tibia[J].J Am Acad Orthop Surg,2008,16(4):228-236.DOI:10.5435/00124635-200804000-00006.
[9] Ofluoglu O,Davidson RS,Dormans JP.Prophylactic bypass grafting and long-term bracing in the management of anterolateral bowing of the tibia and neurofibromatosis-1[J].J Bone Joint Surg Am,2008,90(10):2126-2134.DOI:10.2106/JBJS.G.00272.
[10] Popkov D,Popkov A,Du?i$\grave{c}$ S,et al.Combined technique with hydroxyapatite coated intramedullary nails in treatment of anterolateral bowing of congenital pseudarthrosis of tibia[J].J Orthop,2020,19:189-193.DOI:10.1016/j.jor.2019.11.017.
[11] 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.
[12] Kennedy J,O’Toole P,Baker JF,et al.Guided growth:a novel treatment for anterolateral bowing of the tibia[J].J Pediatr Orthop,2017,37(5):e326-e328.DOI:10.1097/BPO.0000000000000981.
[13] Saran N,Rathjen KE.Guided growth for the correction of pediatric lower limb angular deformity[J].J Am Acad Orthop Surg,2010,18(9):528-536.DOI:10.5435/00124635-201009000-00004.
[14] 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.
[15] 李安平,胡雄科,赵卫华,等.半骺板阻滞术治疗儿童先天性胫骨假关节手术后踝外翻的临床研究[J].临床小儿外科杂志,2021,20(12):1149-1153.DOI:10.12260/lcxewkzz.2021.12.009.Li AP,Hu XK,Zhao WH,et al.Clinical study of hemiepiphyseal treatment for postoperative ankle valgus in children with congenital pseudarthrosis of the tibia[J].J Clin Ped Sur,2021,20(12):1149-1153.DOI:10.12260/lcxewkzz.2021.12.009.
Memo
收稿日期:2023-10-16。
基金项目:儿童骨科学湖南省重点实验室,湖南省卫健委科研课题(20200021)
通讯作者:朱光辉,Email:zgh5650@163.com