Xu Lei,Zhang Yuchen,Zhou Dafei,et al.Analysis of factors influencing the navigated physeal bar resection for the treatment of ankle varus caused by traumatic premature physeal closure of the distal tibial physis in children[J].Journal of Clinical Pediatric Surgery,2024,(11):1009-1014.[doi:10.3760/cma.j.cn101785-202409048-002]
导航下骺开放治疗儿童创伤性胫骨远端骺早闭所致踝内翻的影响因素分析
- Title:
- Analysis of factors influencing the navigated physeal bar resection for the treatment of ankle varus caused by traumatic premature physeal closure of the distal tibial physis in children
- Keywords:
- Physeal Bar Resection; Premature Physeal Closure; Ankle Varus; Growth Potential; Surgical Procedures; Operative; Child
- 摘要:
- 目的 分析导航下骺开放(physeal bar resection,PBR)治疗儿童创伤性胫骨远端骺早闭所致踝内翻畸形的临床特点,探讨影响骺开放成功的相关因素。方法 回顾性分析首都医科大学附属北京积水潭医院小儿骨科2002年6月至2021年10月收治的儿童创伤性胫骨远端骺早闭所致踝内翻,并接受导航下骺开放患儿的临床资料。统计其性别、年龄、受伤机制、骨桥形态、受伤至手术时间、骺阻滞方式、截骨方式、畸形矫正时间,并测量胫骨远端外侧角(lateral distal tibial angle,LDTA)。根据患儿影像学资料,将其分为骺开放成功组及骺开放失败组;以男12岁、女10岁为界,将患儿分为高生长潜力组、低生长潜力组;结合其他临床资料,通过多因素Logistic回归分析影响骺开放成功的因素。结果 本研究共纳入63例患儿,手术时年龄(9.1±2.5)岁,随访32.0(22.0,54.0)个月,受伤至接受骺开放时间为18.0(13.0,28.0)个月。高生长潜力组共47例,其中男30例、女17例;低生长潜力组共16例,其中男9例、女7例。所有患儿接受导航下骺开放手术,同期行胫骨远端外侧骺阻滞25例,同期行截骨11例。骺开放成功组术前LDTA为(108.1±5.5)°,骺开放失败组术前LDTA为(112.7±6.2)°,差异有统计学意义(t=-3.129,P=0.003)。多因素Logistic回归分析结果显示:生长潜力(OR=15.122,95%CI:2.076~110.159,P=0.007)和术前LDTA(OR=0.855,95%CI:0.755~0.969,P=0.014)是骺开放是否成功的独立影响因素。结论 儿童创伤性胫骨远端骺早闭所致踝内翻畸形的骺开放治疗具有挑战性,生长潜力、术前LDTA是影响手术结果的重要因素。准确评估骺板功能及生长潜力、合理手术决策、导航术中精确操作以及术后严密随访是手术成功的关键。
- Abstract:
- Objective To analyze the clinical characteristics of navigated physeal bar resection (PBR) for ankle varus deformity caused by traumatic premature physeal closure of the distal tibial physis in children and to explore the factors influencing the success of the procedure. Methods A retrospective analysis was conducted on pediatric patients with traumatic premature physeal closure of the distal tibial physis resulting in ankle varus who underwent navigated PBR at the Department of Pediatric Orthopedics of Beijing Jishuitan Hospital,Capital Medical University,from June 2002 to October 2021.The clinical data analyzed included gender,age,injury mechanism,bone bridge morphology,time from injury to surgery,method of physeal blockage,osteotomy approach,deformity correction time,and measurement of the lateral distal tibial angle (LDTA).Based on imaging data,patients were divided into successful and failed PBR groups.Patients were also grouped by growth potential,with boys over 12 and girls over 10 classified as having low growth potential.A multivariate logistic regression analysis was performed to identify factors influencing the success of the PBR. Results A total of 63 children were included in the study,with an average age of 9.1 ±2.5 years at the time of surgery and a follow-up period of 32.0(22.0,54.0) months.The time from injury to PBR was 18.0(13.0,28.0) months.There were 47 patients in the high-growth-potential group (30 boys,17 girls) and 16 in the low-growth-potential group (9 boys,7 girls).All patients underwent navigated PBR,with 25 cases receiving concurrent lateral distal tibial physeal blockage and 11 cases undergoing concurrent osteotomy.The preoperative LDTA was 108.1±5.5° in the successful group and 112.7±6.2° in the failed group,showing a statistically significant difference (t=-3.129,P=0.003).Multivariate logistic regression analysis indicated that growth potential (OR=15.122,95%CI:2.076-110.159,P=0.007) and preoperative LDTA (OR=0.855,95%CI:0.755-0.969,P=0.014) were independent factors influencing the success of PBR. Conclusions PBR for ankle varus deformity caused by traumatic premature physeal closure of the distal tibial physis in children is challenging.Growth potential is a critical factor affecting surgical outcomes.Careful patient selection,including accurate assessment of physeal function and growth potential,proper surgical planning,precise navigation-guided procedures,and close postoperative follow-up are key to surgical success.
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备注/Memo
收稿日期:2024-9-19。
基金项目:北京积水潭医院院级科研基金“天玑骨科手术机器人临床应用研究”项目(GCZX202203)
通讯作者:鲁明,Email:lumingit@sina.com