| Background and ObjectiveIn the clinical diagnosis and treatment of pediatric orthopaedics,hypermorphosis and angulation of the lower extremity are common deformities.The overgrowth of the lower limbs is caused by various pathological factors that lead to the overgrowth of the unilateral limbs,which results in the asynchronous growth and development of the bilateral limbs and the length difference.However,the angular deformity of the lower extremity is manifested as genu varus or genu valgus.The angular deformity of the lower extremity can be divided into physiological and pathological deformities.The physiological angular deformity does not need treatment.The etiology of the pathological angular deformity can be summarized as the asymmetrical growth of epiphyseal plate caused by a variety of pathological factors,resulting in the angular deformity of the lower extremity.Overgrowth and pathological angular deformity of the lower limbs not only affect children's mental health and appearance,but also reduce children's ability of gait coordination.If not actively treated,severe claudication,joint injury,pelvis tilt,scoliosis and other complications will occur.Conservative treatment is often used in mild children,including wearing orthopedic braces and raising the short side of the limb.Surgical treatment is often needed for children with severe deformities.Traditional osteotomy is an effective treatment,but the operation is traumatic and has many complications.Because children are in the growth and development period,the recurrence of deformities after the continuous growth of the limbs requires another osteotomy and orthopedic surgery,which is now used as the correction of epiphysis and juvenile deformities.With the continuous understanding of the law of bone growth and development,it is found that epiphysis plays an important role in the process of bone growth in children.Whether it is overgrowth or pathological angular deformity of the lower extremity,epiphyseal block technology can be used to guide the growth of epiphyseal to correct the deformity.After continuous development of epiphyseal block technology,different internal fixation devices are used to treat the lower extremity deformity of children.The typical "U" nail device is designed by Blount and used for temporary epiphyseal block.The internal fixation system can limit the growth of epiphyseal plate and achieve the purpose of gradual orthopedic,but later studies found that the method is easy to lead to complications such as "U" nail fracture and epiphyseal plate early closure.Stevens introduced the "8" plate device on the basis of previous experience and methods.The emergence and application of temporary epiphyseal block with "8" plate provide a safer and more effective method for the treatment of lower extremity deformity in children.By limiting the growth of epiphyseal plate and striving for the time and space to catch up with the growth of one or both epiphyseal plates,the growth of epiphyseal plate can be recovered after the removal of internal fixation device,which is an orthopedic method in line with the characteristics of children's growth and development and an ideal choice for the treatment of children's over growth and angular deformity of lower limbs.In this study,the clinical and imaging data of 30 children with overgrowth and angular deformity of the lower extremity treated by temporary epiphyseal block with "8"plate were analyzed retrospectively,and the changes of various indexes in the course of correction were measured,recorded and analyzed.To explore the effect of "8"plate in the correction of children's overgrowth and angulation deformity,and to provide regular suggestions for the future clinical application of "8" plate temporary epiphyseal block.Materials and MethodsClinical and imaging data of 30 children with hypergrowth and angular deformity of lower limbs treated by temporary epiphyseal block of "8" steel plate were collected from February 2014 to September 2019 in pediatric surgery department of the first affiliated hospital of zhengzhou university.There were 15 males and 15 females.The average age was(7.86±2.20)years.There were 7 cases of hypergrowth of lower limb(7 limbs),4 cases of long left limb and 3 cases of long right limb,all of which were idiopathic hypergrowth.Genu varus in 9 cases(14 limbs),unilateral 4 cases,bilateral 5 cases,idiopathic 3 cases,non-idiopathic(rickets 1 case,Blount disease 1 case).Genu valgus in 14 cases(18 limbs);Unilateral 10 cases,bilateral 4 cases,idiopathic 16 cases,non-idiopathic(1 case of trauma,1 case of osteochondroma).After the surgery,the patient came to the outpatient clinic for reexamination every 3 months,and checked the full-length positive position X-ray films of the weight-bearing lower limbs,and observed the improvement of the appearance and function of the child.The internal fixation device was removed after the correction was satisfactory.After the removal of the internal fixation,the comprehensive evaluation of imaging,appearance and function of the treatment and compared with the preoperative.Radiographic evaluation using contrast before and after surgery the over load of lower limbs is a X ray film and to measure the length difference of lower limbs(legs length discrepancies,LLD)and tibiofemoral Angle(femorotibial angel,FTA),lower limb mechanical axis deviation(mechanichal axis deviation,MAD),distal lateral femoral mechanical shaft Angle(mechanichal lateral distal femoral Angle,MLDFA)and mechichal medial proximal tibia Angle(mMPTA).The Tinetti balance and gait assessment(POMA)was used to evaluate the appearance and function before surgery and after the removal of internal fixation.SPSS 22.0 software was used for statistical analysis,and the data was expressed as(x±s).The observation indexes of the hypergrowth of lower limbs,genu varus and genu valgus were analyzed.Paired t test was used for LLD,FTA,MAD,mLDFA,mMPTA and POMA scores of the satisfaction group before surgery and after steel plate removal.Fisher's exact probability method was used to analyze gender,deformity type(genu varus/valgus)and etiology type in the analysis of the factors affecting the treatment effect in the satisfied and dissatisfied groups,and the independent sample t test was used for age of operation,deformity degree(Angle of angular deformity,difference in length of both lower limbs).The differences were statistically significant at P<0.05.In the study on the time of significant improvement of deformity occurrence in children with satisfactory orthotics,the values of each review time of FTA and LLD were recorded and a line chart was drawn.ResultsAll children were treated with temporary epiphysis block of "8" steel plate,and all the surgeries were performed by the same surgeon.A total of 30 patients with 39 malformed limbs were implanted with 70 "8" steel plates.The average postoperative follow-up time was(24.47±2.57)months.Twenty-three patients(30 limbs,76.9%)were satisfied with the results of limb correction,and seven patients(9 limbs,23.1%)were dissatisfied with the results of limb correction.Screw loosening was observed in one case,and the internal fixation device was replaced by a second operation 6 months after the operation.All the children had good incision healing,normal hip/knee function at the last follow-up,and no complications such as epiphyseal closure and recurrence of deformity occurred in any of the patients.The orthotic satisfaction group included 5 patients with hypergrowth of lower limbs(5 limbs).The mean value of LLD before operation was(32.00±5.83)mm,and the mean value of internal fixation after removal was(7.60±1.14)mm.The average score before POMA was 19.80±0.84 points,and the average score after internal fixation was(26.20±0.83)points.There were 18 cases(25 limbs)with satisfactory orthodontic results,including 10 genu varus and 15 genu valgus.Among the children with satisfactory knee varus correction,the average FTA before surgery was 8.46°±1.20°,and the average FTA after surgery was(3.50°±0.45°).Preoperative average MAD(-33.40±5.13)mm,postoperative average MAD(-7.78±6.79)mm;The mean mMLDA before operation was(102.58°±4.60°),and the mean mMLDA after operation was 91.04°±5.00°).The average mMPTA before operation was(82.16°±1.93°),and the average mMPTA after operation was(88.40°±1.77°).The average preoperative POMA score was(25.70±1.57)points,and the average postoperative POMA score was(27.30±0.82)points.Among the children with satisfactory knee valgus after orthopedics,the average FTA before surgery was(9.79°±1.00°),the average FTA after surgery was(4.39°±0.44°),the average MAD before surgery was(32.50°±2.2°)mm,and the average MAD after surgery was(-0.57±5.61)mm.The average mMLDA before surgery was(79.02°±2.27°),and the average mMLDA after surgery was 89.09°±2.09°.The average mMPTA before operation was 96.94°±2.06°,and the average mMPTA after operation was 88.91°±2.04°.The average preoperative POMA score was(25.73±1.39),and the average postoperative POMA score was 27.40±0.51.The differences of the above indexes between the 30 affected limbs before surgery and when they were taken out and fixed internally were statistically significant(P<0.01),indicating that the children with hypergrowth or angular deformity of the lower limbs were effectively corrected by temporary epiphysis block of "8" steel plate.In the analysis of the factors influencing the treatment effect of children in the satisfaction group(30 limbs)and the dissatisfaction group(9 limbs),the analysis of the factors influencing the treatment effect of children with lower limb angular malformation showed that the indicators with statistical significance were age of operation(t=-2.53,P=0.02),Angle of deformity(t=-7.35,P<0.01),and etiological type(P<0.01).The analysis of the factors related to the failure of lower limb hypergrowth orthodontic showed that the indicators with statistical significance were the operative age(t=-3.19,P=0.02)and the difference of lower limb length(t=-5.73,P<0.01).The results showed that the age of operation,severe malformation(large malformation Angle/lower limb length difference)and non-idiopathic angular malformation were the risk factors affecting the therapeutic effect.The results showed that the age of operation was older,the degree of deformity was more serious(the difference of malformation Angle was larger/lower limb length was larger),and the children with non-idiopathic angular deformity were more likely to fail correction.The values of each review time of FTA and LLD were recorded and a line chart was drawn,showing that the time to correct the occurrence of hypergrowth and angular deformity of lower limbs treated by temporary epiphyseal block of "8" steel plate was about 9-15 months after the operation.After 18 months,the correction rate slowed down significantly.Conclusion1.Temporary hemiphyseal block of "8" steel plate is an effective method to treat children's hypergrowth and angular deformity of lower limbs,which has the advantages of small trauma,rapid postoperative recovery and fewer complications.3.The risk factors that affect the therapeutic effect are the older age of operation,the more serious malformation(the difference between malformation Angle and lower limb length),and the non-idiopathic angular malformation.3.After the treatment of temporary epiphyseal block with "8" steel plate,the deformity was most obviously improved from 9 to 15 months,and the correction rate significantly slowed down after 18 months.4.This study is a retrospective analysis,with case selection bias and a small number of cases,the results may be affected.At the end of the follow-up,the child is still in the growth stage,which requires continuous follow-up to determine the long-term efficacy. |
PDF Full Text Request