8字板矫正儿童多发骨软骨瘤病的膝外翻畸形  

Efficacy of 8-plate hemiepiphysiodesis for genu valgum deformity correction in children with hereditary multiple exostoses

作　　者：张骥[1] 张建立[1] 郭源[1] 王满宜[1] Zhang Ji;Zhang Jianli;Guo Yuan;Wang Manyi(Beijing Jishuitan Hospital,Fourth Medical College,Peking University,Beijing 100035,China)

机构地区：[1]北京大学第四临床医学院(北京积水潭医院),100035

出　　处：《中华小儿外科杂志》2018年第10期769-774,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨8字钢板半侧骺阻滞技术矫正儿童多发性骨软骨瘤病引起的膝外翻畸形的手术时机、方案和短期疗效。方法回顾性分析2009年7月至2014年7月采用8字钢板治疗的骨软骨瘤病膝外翻畸形的病例资料。共15例，男11例，女4例；年龄为4.3～13.5岁（平均10.2岁）；左膝6例，右膝5例，双膝4例。采用股骨远端解剖轴外侧角、胫骨近端内侧角和下肢机械轴偏离度来评价畸形并指导治疗。结果半侧骺阻滞术包括15例股骨和14例胫骨，术后随访时间为9～49个月（平均为26.5个月）。带板时间为5～31个月（平均15.2个月），取板时股骨外翻角度改善5.1°～11.4°（平均7.5°），胫骨外翻角度改善2.3°～14.5°（平均7.0°）。14例股骨矫正速率为0.3°～1.1°/月（平均0.6°/月），12例胫骨矫正速率为0.2°～1.0°/月（平均0.5°/月）。下肢机械轴17例位于－1～＋1区，1例位于＋3区，1例位于－2区，优良率达89.5%。22例骨取板后随诊时间超过6个月，11例外翻角度出现反弹。结论8字钢板半侧骺阻滞技术治疗骨软骨瘤病患儿的膝外翻畸形创伤小，并发症少。只要能及时治疗，合理设计方案，术后密切随诊，均可获得满意的结果。ObjectiveTo explore the surgical timing, technique and prognosis for pediatric genu valgum deformity with hereditary multiple exostoses by 8-plate.MethodsFrom July 2009 to July 2014, the clinical data were reviewed for 15 children of genu valgum deformity with multiple exostoses treated by 8-plate.There were 11 boys and 4 girls with an average age of 10.2 （4.3-13.5） years.The involved knees were left （n=6）, right （n=5） and bilateral （n=4）. Angular deformity changes were evaluated by anatomical lateral distal femoral angle, medial proximal tibial angle and mechanical axis deviation.ResultsHemiepiphysiodesis included 15 femurs and 14 tibias.The average follow-up period was 26.5 （9-49） months.The average duration from stapling to staple removal was 15.2 （5-31） months.Amount of angular correction by 8-plate at distal femur was 5.1～11.4°（averaged 7.5°） and at proximal tibia, 2.3～14.5°（averaged 7.0°）. Correction velocity at 14 femurs was 0.3～1.1°/M （averaged 0.6°/M） and at 12 tibias 0.2～1.0°/M（averaged 0.5°/M）. Seventeen legs had mechanical axes in zone ＋ 1 or -1, one leg in zone ＋ 3, one leg in zone -2 and the total good rate reached 89.5%.There were 22 femurs or tibias with a follow-up period of 〉6 months after 8-plate removal.Eleven rebounded at the latest follow-up.ConclusionsThe technique of 8-plate hemiepiphysiodesis is mini-invasive and effective for pediatric genu valgum deformity with hereditary multiple exostoses.Patients should be treated promptly, rational therapeutic regimen provided and close monitor mandatory until skeletal maturity.

关 键 词：外生骨疣 多发性遗传性 膝外翻 生长面 

分 类 号：R738.3[医药卫生—肿瘤]