临时半骺阻滞术治疗儿童病理性骺板所致膝内、外翻畸形  

Temporary hemiepiphysiodesis for treatment of genu varum and valgum with pathologic physis in children

作　　者：邓书贞[1] 杨建平[1] 陈兆强[1] 张中礼[1] 龚仁钰[1] 王春会[1] 

机构地区：[1]天津市天津医院小儿骨科,300211

出　　处：《中华骨科杂志》2017年第24期1561-1568,共8页Chinese Journal of Orthopaedics

摘　　要：目的 回顾性分析临时半骺阻滞术治疗儿童病理性骺板所致膝内、外翻的临床疗效。方法 2008年1月至2014年12月收治31例患儿（52膝）均采用＂8＂字钢板行临时半骺阻滞术。男20例，女11例；年龄2岁4个月~13岁4个月，平均6岁5个月。内翻12例（23膝），外翻19例（29膝）；单侧10例，双侧21例；股骨41例，胫骨44例。评估指标采用手术前后下肢机械轴线偏移（mechanichal axis deviation, MAD）并测量机械轴股骨远端外侧角（mechanichal lateral distal femoral angle, mLDFA）和胫骨近端内侧角（mechanichal medial proximal tibia angle, mMPTA）。根据Stenven提出的膝关节分区（内翻为负，外翻为正），去除钢板时MAD位于±1区域，视为矫正效果满意；位于±1区域之外，视为矫正效果不满意。对矫正效果满意患儿行统计分析并观察骺板厚度及形态变化。对矫正满意组与不满意组的性别、单双侧、手术年龄、畸形部位（股骨、胫骨）、畸形种类（内翻、外翻）以及畸形角度进行单因素分析，再行Logistic多因素回归分析判断影响治疗效果的因素。末次随访时记录膝关节屈伸功能及畸形复发情况。结果 术后随访时间2年6个月~9年5个月，平均4年1个月。44膝（84.6%）矫正效果满意，膝内翻21膝MAD术前平均（-33.3±7.2）mm，去除钢板时平均（2.1±4.3）mm；mLDFA术前平均102.9°±4.9°，去除钢板时平均85.3°±3.8°；mMPTA术前平均81.2°±3.4°，去除钢板时平均90.5°±4.4°；膝外翻23膝MAD术前平均（29.3±6.8）mm，去除钢板时平均（-4.1±6.5）mm；mLDFA术前平均79.5°±5.7°，去除钢板时平均88.1°±3.5°；mMPTA术前平均97.0°±4.3°，去除钢板时平均87.1°±5.2°，差异均有统计学意义。矫正效果满意的44膝中28膝术前存在骺板内、外侧厚度不对称，术后明显改善，骺板形态趋于正常。8膝（15.4%）矫正效果不满意（内翻2膝、外翻6膝�Objective To retrospectively analysis the clinical effect of temporary hemiepiphysiodesis for treatment of genu varus and valgus with pathologic physis in children.Methods All of 31 children （52 knees） were included in the study from January 2008 to December 2014, 20 boys and 11 girls, the age at the time of surgery from 2 year 4 month to 13 year 4 month, mean 6 year 5 month. 12 varus and 19 valgus, 10 unilateral and 21 bilateral, 41 femurs and 44 tibias. The Mechanichal Axis Deviation （MAD） was evaluated and the mechanical lateral distal femur angle （mLDFA） and medial proximal tibia angle （mMPTA） pre-operation and post-surgery was measured. Judging the efficacy with zone system for assessing mechanical axis based on Stevens, we think the results was satisfactory if the mechanical axis falls in zone ±1 when removed the eight-plate and other was unsatisfactory. We made statistical analysis of children who were corrected satisfactory and observed the change of the width and appearance of the physis. We also made the univariate analysis and Logistical multivariate regression analysis about sex, unilateral or bilateral, surgery age, femur or tibia, varus or valgus and severity of deformity to judge the influencing factors between satisfactory and unsatisfactory. We recorded the knee function and deformity recurrence at last follow up.Results The follow-up period was 2 year 6 month to 9 year 5 month, mean 4 year 1 month, 44 knees （84.6%） were corrected satisfactory. The mean value of MAD at pre-surgery and at the time when the plate was removed were （-33.3±7.2） mm and（2.1±4.3） mm, mean mLDFA were 102.9°±4.9° and 85.3°±3.8°, mean mMPTA were 81.2°±3.4° and 90.5°±4.4° in genu varus （21 knees）; The meam value of MAD at pre-surgery and at the time when the plate was removed were 29.3±6.8 mm and -4.1±6.5 mm, and the mean mLDFA were 79.5°±5.7° and 88.1°±3.5°, mean mMPTA was 97.0°±4.3° and 87.1°±5.2° in genu valgus （23 knees）, which were significant difference.

关 键 词：膝内翻 膝外翻 生长面 内固定器 

分 类 号：R726.8[医药卫生—儿科]