Cai Haojie,Zhu Guanghui.Treatment efficacy of tibial proximal varus deformity by partial physeal arrest after surgery for congenital pseudarthosis of the tibia[J].Journal of Clinical Pediatric Surgery,,():1032-1036.[doi:10.3760/cma.j.cn101785-202403055-007]
Treatment efficacy of tibial proximal varus deformity by partial physeal arrest after surgery for congenital pseudarthosis of the tibia
- Keywords:
- Menisci; Tibial; Growth Plate; Epiphysiodesis; Surgical Procedures; Child
- Abstract:
- Objective To preliminarily explore the timing of removing internal fixation for correcting congenital pseudarthosis of the tibia (CPT) after hemiepiphyseal blocking. Methods A retrospective analysis was conducted for the relevant clinical data of 39 children with proximal tibial eversion after CPT undergoing 8-shaped steel plate semi epiphyseal blocking at Department of Orthopedics,Hunan Children’s Hospital from January 2012 to November 2022.According to the correction value of anterior mechanical proximal tibial angle (aMPTA) during plating,they were assigned into three groups of A (n=11,≥87°),B (n=21,82-87°) and C (≤82°,n=7).General profiles,radiographic images of the tibia and fibula were acquired at preoperation,during internal fixation removal and at the last follow-up,internal fixation time and follow-up time after removal of internal fixation.The parameters of aMPTA,anterior lateral femoral angle (aLDFA),posterior proximal tibial angle (PPTA) and posterior distal femoral angle (PDFA) at preoperation,during internal fixation removal and at the last follow-up were statistically analyzed for exploring an optimal range of correction angles. Results There were 22 boys and 17 girls.The involved side was left (n=22) and right (n=17).No statistically significant differences existed in age,gender,total follow-up time or follow-up time after removal of internal fixation among three groups during surgery (P>0.05).In group A,aMPTA was (99.63±6.44)° before surgery and (89.53±2.60)° during internal fixation.At the last follow-up,aMPTA was (90.63±1.93)° with a rebound degree of (2.57±1.71)° and an average monthly correction rate of (0.96±0.53)°; Before surgery,aMPTA of group B was (97.81±5.09)° and (84.62±0.99)° during internal fixation.At the last follow-up,aMPTA was (87.11±1.89)° with a rebound degree of (2.84±1.00)° and an average monthly correction rate of (1.19±0.74)°; Before surgery,MPTA of group C was (93.57±5.55)° and (78.71±1.98)° during internal fixation.At the last follow-up,aMPTA was (87.20±3.12)° with a rebound degree of (8.49±3.64)° and an average monthly correction rate of (1.38±0.87)°.During follow-ups,there were 2 cases of screw loosening without such complications as internal fixation fracture,internal fixation failure,infection or epiphyseal plate injury.Inter-group comparison revealed statistically significant differences in aMPTA among three groups during internal fixation and at the last follow-up (P<0.01).At the last follow-up,statistically significant difference existed in aMPTA between groups A and B,as well as between groups A and C (P<0.01); No statistically significant difference existed in aMPTA between groups B and C (P>0.05).Statistically significant differences existed in aLDFA,PPTA,PDFA and correction rate before surgery,during internal fixation and at the last follow-up (P>0.05).The difference in rebound degree was statistically significant (P<0.01).The differences of rebound degree were statistically significant between groups A/C and B/C (P<0.01) while no statistically significant difference existed in rebound degree between groups A and B (P>0.05).Group C had the highest rebound degree. Conclusions When using semi epiphyseal blocking for treating congenital tibial pseudarthrosis in children,aMPTA is ideally set between 82-87° during internal fixation.
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Memo
收稿日期:2024-3-27。
基金项目:儿童骨科学湖南省重点实验室专项经费(2023TP1019);国家重点研发计划-骨科难治性疾病诊疗新模式建立、评价及推广应用(2023YFC2507605);湖南省儿童肢体畸形临床医学研究中心(2019SK4006)
通讯作者:朱光辉,Email:zgh5650@163.com