使用冠状定向 8 号钢板进行股骨远端前半截骨切除术矫正儿童固定性膝关节屈曲畸形--初步结果。

IF 1.4 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2024-10-01 Epub Date: 2024-06-06 DOI:10.1097/BPO.0000000000002746
Mohamed Y Hassanein, Mohamed Khaled, Mahmoud Yahya Hassanein, Nariman Abol Oyoun
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引用次数: 0

摘要

简介:用于矫正小儿固定性膝关节屈曲畸形(FKFDs)的股骨远端引导性生长的原始技术包括在蹄状沟两侧插入两块8号钢板,这种技术经常与术后膝关节持续疼痛和皱褶有关。本研究旨在评估一种新技术的初步结果,即在冠状面上固定两块 8 号钢板,内侧和外侧各一块,使其占据股骨远端前部:我们的研究是一项前瞻性病例系列研究,研究对象包括膝关节屈曲畸形大于 10 度的病例,这些儿童至少还有 12 个月的预测生长期。术前记录膝关节屈曲挛缩角度。手术方法是在股骨远端内侧和外侧植入两块冠状方向的8椎板,尽可能使其位于股骨轴线的前方,同时不侵犯蹄状沟。记录达到完全伸膝所需的时间和遇到的并发症。采用Wilcoxon符号秩方法比较术前和最终的挛缩角度。统计显著性水平设定为PResults:共纳入 8 名患者(6 名男孩和 2 名女孩)的 13 个膝关节。年龄中位数为 11 岁(6 至 14 岁)。所有患者的股骨远端发育不良程度均有明显改善,从 25 度(14 至 42 度)降至 0 度(-9 至 8 度):使用冠状方向的 8 型钢板引导股骨远端生长是治疗儿童 FKFD 的有效方法。与传统技术相比,这种改良技术可实现更快的矫正,同时将术后膝关节疼痛的风险降至最低:证据等级:IV级-病例系列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anterior Distal Femoral Hemiepiphysiodesis Using Coronally Oriented 8-plates for the Correction of Fixed Knee Flexion Deformities in Children-Preliminary Results.

Introduction: The original technique for guided growth of the distal femur for correction of pediatric fixed knee flexion deformities (FKFDs) involves the utilization of two 8-plates inserted on either side of the trochlear groove, a technique that has been frequently linked to the development of persistent postoperative knee pain and crepitus. The present study aimed to assess the preliminary results of a novel technique where the two 8-plates are fixed in the coronal plane, one on each of the medial and lateral surfaces, so that they occupy the anterior part of the distal femur.

Methods: Our study was a prospective case series that included cases with FKFD of >10 degrees in children with at least 12 months of predicted growth remaining. The preoperative knee flexion contracture angle was documented. The surgical procedure entailed the insertion of 2 coronally oriented 8-plates on the medial and lateral surfaces of the distal femur as anterior as possible to the axis of the femur without encroachment on the trochlear groove. The duration of time required to attain full knee extension and any complications encountered were recorded. Wilcoxon signed-rank was used to compare the preoperative and final contracture angles. The level of statistical significance was set at P <0.05.

Results: Thirteen knees in 8 patients (6 boys and 2 girls) were included. The median age was 11 years (6 to 14). There was a significant improvement in the FKFD for the whole cohort from 25 degrees (14 to 42) to 0 degrees (-9 to 8), P <0.05. The median rate of correction was 2.0 degrees/month (0.9 to 5.8). The time till full correction was 14 months (4 to 25). Postoperative knee pain and metalware-related complications were not reported by any patient during follow-up.

Conclusions: Guided growth of the distal femur using coronally oriented 8-plates is an effective procedure for the treatment of FKFDs in children. This modified technique may achieve faster correction while minimizing the risk of postoperative knee pain compared with the conventional technique.

Level of evidence: Level IV-case series.

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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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