The Effect of Rotational Guided Growth With Flexible Tethers on the Distal Femoral Bone: An Experimental Study in a Porcine Model

IF 2.1 3区 医学 Q2 ORTHOPEDICS
Ahmed Halloum, Maria Tirta, Søren Kold, Shima Gholinezhad, Jan Duedal Rölfing, John Rasmussen, Ahmed A. Abood, Ole Rahbek
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Abstract

New and innovative surgical techniques, using a flexible tether to correct rotational deformities of the growing femur have recently emerged, but are lacking radiographic validation of desired rotation and adverse effects in the frontal and sagittal planes. We, therefore, investigated this new technique in an established large animal model. Eight skeletally immature pigs were included in the study in a paired (left vs. right leg) design. Mean (range) observation time was 83 days (77–90). CT-scans and X-rays were performed immediately after insertion of the tethers and again at euthanasia after 12 weeks. From the CT-scans, 3D-models of the left and right femora were generated and analyzed for intended external rotation and unintended effects in other planes and bone morphology. One pig was excluded due to surgical site infection. Average change in rotation between the operated and non-operated femora was 7.2° (CI: 5.9–8.6) external rotation. We also found unintended valgus deformity in the coronal plane (7.8° (CI: 3.9–12.0) and unintended extension in the sagittal plane (3.9° (CI: −1.8 to 8.7). Unintended changes to the joint morphology were also observed. Rotation by guided growth was achieved with this surgical technique, confirmed by radiological measurements.

Clinical Significance. While this large animal study has shown that this new surgical technique reliably corrected rotational deformities by guided growth, it has also revealed adverse effects that need further investigation before clinical use.

Abstract Image

猪股骨远端骨弹性系带旋转引导生长的实验研究。
最近出现了新的和创新的手术技术,使用灵活的系索来纠正股骨生长中的旋转畸形,但缺乏放射学验证所需的旋转和对额位和矢状面的不良影响。因此,我们在一个已建立的大型动物模型中研究了这种新技术。8只骨骼未发育成熟的猪被纳入研究,采用配对(左腿vs右腿)设计。平均(极差)观察时间83天(77 ~ 90天)。在插入系索后立即进行ct扫描和x光检查,并在12周后安乐死时再次进行扫描。从ct扫描中,生成了左右股骨的3d模型,并分析了预期的外部旋转和其他平面和骨形态的意外影响。1头猪因手术部位感染被排除。手术和非手术股骨的平均旋转变化为7.2°(CI: 5.9-8.6)外旋。我们还发现冠状面意外外翻畸形(7.8°(CI: 3.9-12.0))和矢状面意外外翻畸形(3.9°(CI: -1.8 - 8.7))。还观察到关节形态的意外变化。该手术技术通过引导生长实现旋转,放射学测量证实了这一点。临床意义。虽然这项大型动物研究表明,这种新的手术技术通过引导生长可靠地纠正了旋转畸形,但它也揭示了在临床应用前需要进一步研究的副作用。
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来源期刊
Journal of Orthopaedic Research®
Journal of Orthopaedic Research® 医学-整形外科
CiteScore
6.10
自引率
3.60%
发文量
261
审稿时长
3-6 weeks
期刊介绍: The Journal of Orthopaedic Research is the forum for the rapid publication of high quality reports of new information on the full spectrum of orthopaedic research, including life sciences, engineering, translational, and clinical studies.
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