8字钢板临时阻滞在儿童下肢不等长中的应用效果分析

Efficiency of temporary hemiepiphysiodesis with eight-plate in children with lower limb discrepancy

目的探讨8字钢板临时骨骺阻滞在儿童下肢不等长(lower limb discrepancy,LDD)治疗中的有效性及可行性。方法回顾性分析自2011年11月至2017年1月复旦大学附属儿科医院小儿骨科收治的14例LLD患儿临床资料,通过双下肢全长站立位X线片测量术前、术后股骨、胫骨长度变化,通过生长曲线分析使用8字钢板临时阻滞术后肢体不等长的改善情况,计算其在骨骺阻滞中的作用和效率。结果对14例患儿共17个部位(股骨远端及胫骨近端)行内外侧联合8字钢板阻滞,平均随访时间(29.4±8.53)个月,阻滞长度中位数为18.8 mm(5~40 mm),平均阻滞率为(59.5±18.0)%。本组病例均未出现骨骺早闭及骺板损伤的情况。此外通过分析发现,阻滞部位(胫骨近端或股骨远端)、年龄、性别、侧别对阻滞率没有影响(P>0.05),而骨骺阻滞时间与阻滞率呈正相关(r=0.438,P<0.05)。结论8字钢板在LLD中的临时性骨骺阻滞为非完全性阻滞,可以作为LLD病人治疗的一种选择,但是其矫形能力有限,术前应充分评估患儿的生长潜力。此外,术后密切随访也是取得理想治疗效果的关键。

Objective To explore the efficacy and feasibility of temporary hemiepiphysiodesis with eight-plate for children with lower limb discrepancy(LLD).Methods A retrospective study was conducted for LLD children from November 2011 to January 2017.Radiological assessments were performed by standing full-length X-ray.By analyzing the change of the length of bones after temporary hemiepiphysiodesis with eight-plate,retarding efficiency was calculated according to the growth curve of eight-plate.Results A total of 14 patients(17 physes)were included.The average follow-up period was 29.4(29.4±8.53)months,the average blocking length was 18.8(5-40)mm and the average blocking rate was 59.5%(0.595±0.18).No epiphyseal closure or epiphyseal plate injury occurred.No statistical differences existed in site(proximal tibia or distal femur),age,gender or sideness.Blocking rate was positively correlated with blocking time(r=0.438,P<0.05).Conclusion Temporary epiphyseal blocking of 8-plate in LLD is incomplete and it may be an alternative treatment for LLD children.However,for its limited correction efficacy,growth potential should be fully evaluated.And close postoperative follow-up is also vital for achieving an excellent outcome.