8字钢板技术治疗小儿下肢成角畸形及肢体过度生长44例

Correction of length discrepancies ＆ angular deformeties of the limbs in children by 8-plate ： A series of 44 cases.

目的通过分析临床资料及定期随访，探讨8字钢板临时骺阻滞技术（生长引导技术）在小儿下肢成角畸形及控制肢体过度生长中的应用及相关并发症的处理。方法2009年5月至2012年10月，我们应用8字钢板临时骺阻滞技术，对44例（共61例患肢）存在下肢成角畸形及肢体过度生长的患儿进行矫治。通过影像学检查，随访患儿术后下肢成角及长度变化。结果上述患儿术后随访5—36个月，其中膝关节矢状面、冠状面成角共50例患肢，术后股骨一胫骨角（Femur—Tibiaangular，FTA）平均纠正9．1°；胫骨弯曲畸形1例，术后纠正8°；踝关节外翻1例，胫骨与远端平面成角（Lateraldistaltibialangle，LDTA）纠正11°。肢体过度生长共13例患肢，术后下肢长度差平均减少0．5cm。上述病例中，13例患儿已拆除钢板。1例因阻滞螺钉松动，于术后7个月更换；1例K—T综合征患儿拆除钢板时发现骺板变形。1例下肢成角畸形患儿因术后骺阻滞、螺钉意外断裂更换。本组病例中未发现骺早闭、伤口感染及畸形复发等情况。结论应用8字钢板临时骺阻滞技术，可以有效矫正有生长潜力的下肢成角畸形，限制肢体过度生长，且具有操作简单，创伤小，术后恢复快，花费低，并发症相对较少等优点，但在临床治疗中仍需注意掌握其适应证和技术要点，规范操作，定期随访，并积极预防、及时发现、妥善处理相关并发症。

Objetive To discuss the effectiveness and complications of 8-plate in dealing with the cor- rection of length discrepancies ＆ angular deformeties of the limbs in children according to the clinical data and regular follow-up. Methods We treated 44children with length discrepancies ＆ angular deformeties of the limbs （61 limbs） by 8-plate during 2009/5 -2012/10. Regular follow-up was enrolled after the operation. Re- suits We found that After 5 - 36 months＇ follow-up, the Femur-Tibia angular（FTA） of the 50 knees with an- gular deformity（Sagittal plane, Coronal Plane） decreased 9：1°, the angle of the curved tibia（ 1 limb） de- creased 8°, the lateral distal tibial angle（LDTA） of the ankle valgus decreased 11 °, the length difference of lower limbs decreased 0.5 cm. Of all the 44 cases, 13 cases had finished the treatment and removed the plates, one child＇ s plate had been changed because of the loosening of the screw, another had been changed because of being broken, the third one had been removed because of the deformation of the Epiphyseal plate. Epipbyseal closure, infection and recurrence of the malformation were not found in all cases. Conclusion The 8-plate temporaL＇y eplphyrsiodesis technique, which is simple, cheap, well tolerated and with less complications can correct the angular deformities and the length discrepancies of the limbs effectively. More attention should be paid to the indications, operation standards, regular follow-up, disease prevention and the complications.