摘要
目的 探讨"8"字钢板临时骨骺阻滞技术治疗儿童双下肢不等长的阻滞效果.方法 回顾性分析2013年1月至2020年7月北京积水潭医院小儿骨科采用"8"字钢板治疗的双下肢不等长患儿49例,男27例、女22例,手术时年龄为(8.8±2.6)岁(范围3.8～13.1岁).术前通过下肢全长X线片测量股骨和胫骨的长度差异,应用"8"字钢板在较长腿的股骨远端和(或)胫骨近端骺板内、外侧分别跨骨骺固定以减速生长.随访中于膝关节正侧位X线片评估局部骺板形态及内固定情况,双下肢全长X线片对比手术前后股骨、胫骨长度差变化,以评估阻滞手术效果;并按照阻滞部位(股骨或胫骨)、病因(不等长差距恒定或增加)、阻滞螺钉直径(3.5或4.5 mm)以及阻滞时年龄(≥8岁或＜8岁)进行分组,对比阻滞速率的差异.结果 49例均顺利完成手术,随访时间为(39.6±18.5)个月(范围16～91个月),钢板固定时间为(24.3±11.8)个月(范围7～66个月).共获得76个独立的单骨阻滞数据资料,阻滞幅度为(8.6±6.4)mm(范围-8～37 mm).76个单骨阻滞速率为(0.35±0.31)mm/月,其中52个股骨的阻滞速率为(0.41±0.32)mm/月,较24个胫骨的(0.20±0.14)mm/月长,差异有统计学意义(t=5.323,P=0.008);双下肢不等长差距恒定组阻滞速率为(0.54±0.32)mm/月,较双下肢不等长差距增加组的(0.26±0.21)mm/月长,差异有统计学意义(t=7.362,P=0.001);直径4.5 mm螺钉组阻滞速率为(0.46±0.23)mm/月,较直径3.5 mm螺钉组的(0.26±0.24)mm/月长,差异有统计学意义(t=3.467,P=0.022);＜8岁组30骨阻滞速率(0.32±0.25)mm/月、≥8岁组46骨为(0.37±0.31)mm/月,差异无统计学意义(t=1.026,P=0.548).结论 "8"字钢板临时骨骺阻滞技术治疗双下肢不等长的阻滞效果与原始病因及阻滞部位有关,股骨远端阻滞效果优于胫骨近端,双下肢不等长差距恒定者阻滞效果优于差距增加者,应用较粗的螺钉效果更好.由于阻滞效果较缓慢,应当早期治疗、合理选择适应证以获得更佳阻滞效果.
Abstract
Objective To explore the blocking effect of temporary epiphysiodesis technique with"8"-plate in the treat-ment of leg length discrepancy(LLD)in children.Methods From January 2013 to July 2020,49 children(27 males and 22 fe-males)with leg length discrepancy treated with"8"-plate in Pediatric Orthopedics Department of Beijing Jishuitan hospital were analyzed retrospectively.The average age at the time of surgery was 8.8±2.6 years(ranging from 3.8 to 13.1 years).The length dif-ference between femur and tibia was measured before operation on full-length X-ray films of lower limbs,and the"8"-plate was placed on both medial and lateral sides of the distal femur and/or the proximal tibia.During the follow-up,the shape of epiphyseal plate and internal fixation change were evaluated on X-ray films of the knee joint,and the length difference before and after the op-eration was compared to evaluate the blocking effect.The blocking rate was compared according to the following conditions:the blocking position(femur,tibia),classification of LLD(constant or increasing),screw diameter(3.5 mm or 4.5 mm)and the age at operation(≥8 or＜8 years).Results 49 patients were successfully operated.The follow-up time was 39.6±18.5 months(range 16-91 months)with the fixing time of 24.3±11.8 months(range 7-66 months).A total of 76 independent data of single bone were ob-tained.The correction range was 8.6±6.4 mm(range-8-37 mm).The correction rate was 0.35±0.31 mm/month.The correction rate of 52 femurs was 0.41±0.32 mm/month,which was significant higher than that of 24 tibias with 0.20±0.14mm/month(t=5.323,P=0.008).The correction rate of the constant group with 0.54±0.32 mm/month was obviously better than the increasing group with 0.26±0.21 mm/month(t=7.362,P=0.001).The average correction rate of 4.5 mm diameter screw group was 0.46±0.23 mm/month,which was significantly better than that of 3.5 mm diameter screw group with 0.26±0.24 mm/month(t=3.467,P=0.022).The correc-tion rate in the group of＜8 years old was 0.32±0.25 mm/month,which was not significantly different from that in the group of ≥8 years old with 0.37±0.31 mm/month(t=1.026,P=0.548).Conclusion The blocking effect of"8"-plate temporary epiphysiodesis technique in the treatment of leg length discrepancy was related to the LLD classification and blocking position.Distal femoral block was better than proximal tibia block.Block effect of patients with constant unequal distance between lower limbs was better than that of patients with increased distance.4.5 mm diameter screw was better than 3.5mm.Because the blocking effect was slow,early treatment and a firm stick to indications was of great importance.
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