{"title":"胫骨后屈的引导生长。","authors":"Peter Stevens, Andrew Stephens, David Rothberg","doi":"10.5005/jp-journals-10080-1535","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim and objective: </strong>Sagittal guided growth of the distal anterior femur has been shown to be effective for the correction of fixed knee flexion deformity that is encountered in clinical practice. The opposite deformity, namely genu recurvatum, is comparatively uncommon in children. The most common aetiology is post-traumatic. Acute correction by means of osteotomy has significant associated risks. Our objective was to determine whether a posterior 8-plate would suffice in correcting tibial recurvatum and obviate the need for an osteotomy.</p><p><strong>Materials and methods: </strong>We included a total of five deformities, three boys (one bilateral) and one girl, managed by means of tethering of the posterior proximal tibial physis with a tension band plate. Standard radiographs obtained preoperatively and at follow-up included a standing anteroposterior (AP) of the legs noting limb lengths and the mechanical axis. We also obtained standing lateral views of each knee in maximal extension to measure and compare the posterior proximal tibial angle (PPTA).</p><p><strong>Results: </strong>The same-day surgery was well tolerated and there were no surgical or post-operative complications. The preoperative PPTA ranged from 106° to 117° and averaged 84° at follow-up. Correction occurred in an average of 20 months (range of 18-24 months). The patient with bilateral recurvatum due to Hurler's syndrome developed unilateral recurrent recurvatum culminating in percutaneous reinsertion of the metaphyseal screw. For each patient, knee hyperextension and associated pseudo-laxity resolved and limb lengths remained equal at follow-up.</p><p><strong>Conclusion: </strong>Children with progressive genu recurvatum typically present with an insidious onset of symptoms. Guided growth of the posterior proximal tibia is a safe and effective means of correcting the deformity; osteotomy was avoided in this series.</p><p><strong>Level of evidence: </strong>III - retrospective case series - no controls.</p><p><strong>How to cite this article: </strong>Stevens P, Stephens A, Rothberg D. Guided Growth for Tibial Recurvatum. Strategies Trauma Limb Reconstr 2021;16(3):172-175.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 3","pages":"172-175"},"PeriodicalIF":1.0000,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/67/95/stlr-16-172.PMC8778727.pdf","citationCount":"2","resultStr":"{\"title\":\"Guided Growth for Tibial Recurvatum.\",\"authors\":\"Peter Stevens, Andrew Stephens, David Rothberg\",\"doi\":\"10.5005/jp-journals-10080-1535\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aim and objective: </strong>Sagittal guided growth of the distal anterior femur has been shown to be effective for the correction of fixed knee flexion deformity that is encountered in clinical practice. The opposite deformity, namely genu recurvatum, is comparatively uncommon in children. The most common aetiology is post-traumatic. 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引用次数: 2
摘要
目的和目的:矢状面引导下股骨远端前段生长已被证明对临床上遇到的固定膝关节屈曲畸形的矫正是有效的。相反的畸形，即膝后屈，在儿童中比较少见。最常见的病因是创伤后。通过截骨术进行急性矫正有显著的相关风险。我们的目的是确定后路8号钢板是否足以矫正胫骨后凸并避免截骨手术。材料和方法:我们共纳入5例畸形，3例男孩(1例双侧)和1例女孩，采用张力带钢板系住胫骨后近端物理。术前和随访时获得的标准x线片包括站立正位(AP)，记录肢体长度和机械轴。我们还获得了每个膝关节最大伸展时的站立侧位视图，以测量和比较胫骨后近端角(PPTA)。结果:当日手术耐受良好，无手术及术后并发症。术前PPTA为106°~ 117°，随访时平均为84°。修正发生在平均20个月(18-24个月)。由于赫勒综合征而出现双侧复发的患者发展为单侧复发性复发，最终经皮重新插入干骺端螺钉。在随访中，每位患者的膝关节过伸和相关的假性松弛得到缓解，肢体长度保持不变。结论:儿童进行性膝反屈通常表现出潜伏的发病症状。胫骨后近端引导生长是一种安全有效的矫正畸形的方法;本病例均避免截骨。证据等级:III级-回顾性病例系列-无对照。本文来源:Stevens P, Stephens A, Rothberg D.胫骨反曲的引导生长。创伤肢体重建[j]; 2011;16(3):172-175。
Aim and objective: Sagittal guided growth of the distal anterior femur has been shown to be effective for the correction of fixed knee flexion deformity that is encountered in clinical practice. The opposite deformity, namely genu recurvatum, is comparatively uncommon in children. The most common aetiology is post-traumatic. Acute correction by means of osteotomy has significant associated risks. Our objective was to determine whether a posterior 8-plate would suffice in correcting tibial recurvatum and obviate the need for an osteotomy.
Materials and methods: We included a total of five deformities, three boys (one bilateral) and one girl, managed by means of tethering of the posterior proximal tibial physis with a tension band plate. Standard radiographs obtained preoperatively and at follow-up included a standing anteroposterior (AP) of the legs noting limb lengths and the mechanical axis. We also obtained standing lateral views of each knee in maximal extension to measure and compare the posterior proximal tibial angle (PPTA).
Results: The same-day surgery was well tolerated and there were no surgical or post-operative complications. The preoperative PPTA ranged from 106° to 117° and averaged 84° at follow-up. Correction occurred in an average of 20 months (range of 18-24 months). The patient with bilateral recurvatum due to Hurler's syndrome developed unilateral recurrent recurvatum culminating in percutaneous reinsertion of the metaphyseal screw. For each patient, knee hyperextension and associated pseudo-laxity resolved and limb lengths remained equal at follow-up.
Conclusion: Children with progressive genu recurvatum typically present with an insidious onset of symptoms. Guided growth of the posterior proximal tibia is a safe and effective means of correcting the deformity; osteotomy was avoided in this series.
Level of evidence: III - retrospective case series - no controls.
How to cite this article: Stevens P, Stephens A, Rothberg D. Guided Growth for Tibial Recurvatum. Strategies Trauma Limb Reconstr 2021;16(3):172-175.
期刊介绍：
Strategies in Trauma and Limb Reconstruction is dedicated to surgeons, allied medical professionals and researchers in the field of orthopaedics and trauma. The scope of the journal is to discuss the fields of skeletal injury, and the complications thereof, congenital and acquired limb deformities and deficiencies, and orthopaedic-related infection, together with their surgical and non-surgical treatments. The journal publishes original articles, reviews, case reports, descriptions of new or recognised treatment techniques, forum discussions of clinical scenarios and relevant correspondence. It aims to provide a widely accessible source of useful information to practitioners in the field through the problem- or technique-based approach of published articles.
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