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Objective To retrospectively analysis the clinical effect of temporary hemiepiphysiodesis for treatment of genu varus and valgus with pathologic physis in children.Methods All of 31 children (52 knees) were included in the study from January 2008 to December 2014,20 boys and 11 girls,the age at the time of surgery from 2 year 4 month to 13 year 4 month,mean 6 year 5 month.12 varus and 19 valgus,10 unilateral and 21 bilateral,41 femurs and 44 tibias.The Mechanichal Axis Deviation (MAD) was evaluated and the mechanical lateral distal femur angle (mLDFA) and medial proximal tibia angle (mMPTA) pre-operation and post-surgery was measured.Judging the efficacy with zone system for assessing mechanical axis based on Stevens,we think the results was satisfactory if the mechanical axis falls in zone ± 1 when removed the eightplate and other was unsatisfactory.We made statistical analysis of children who were corrected satisfactory and observed the change of the width and appearance of the physis.We also made the univariate analysis and Logistical multivariate regression analysis about sex,unilateral or bilateral,surgery age,femur or tibia,varus or valgus and severity of deformity to judge the influencing factors between satisfactory and unsatisfactory.We recorded the knee function and deformity recurrence at last follow up.Results The follow-up period was 2 year 6 month to 9 year 5 month,mean 4 year 1 month,44 knees (84.6％) were corrected satisfactory.The mean value of MAD at pre-surgery and at the time when the plate was removed were (-33.3t7.2) mm and (2.1 ±4.3) mm,mean mLDFA were 102.9°±4.9° and 85.3°±3.8°,mean mMPTA were 81.2°±3.4° and 90.5° ±4.4° in genu varus (21 knees);The meam value of MAD at pre-surgery and at the time when the plate was removed were 29.3±6.8 mm and-4.1±6.5 mm,and the mean mLDFA were 79.5o±5.7° and 88.1°±3.5°,mean mMPTA was 97.0°±4.3° and 87.1°±5.2° in genu valgus (23 knees),which were significant difference.There were 28 knees with physis width asymmetry in the 44 knees pre-operation and improved obviously after-surgery and the appearance became normally.8 knees corrected unsatisfactory included 2 varus and 6 valgus.The severity of deformity was a risk factor that affects efficacy with univariate analysis(t=5.124,P=0.000).Regarding the range of the age,we also did the logistic multivariate regression analysis with results showing that surgery age (OR=1.032) and se verity of deformity (OR=1.335) were related to the outcome.There were 8 knees in the 44 knees which had deformity recurrence and the rate was 19.5％ (8/41,3 knees excluded due to doing the limb lengthening surgery when removing the plate) at last follow up,and the knees function were normal.Conclusion Temporary hemiepiphysiodesis is a minimally invasive and effective method for treatment of genu varus or valgus with pathologic physis in children and could improve the appearance of the physis.The age at surgery and severity of deformity are the risk factors that affect efficacy.The pathological changes persisted could cause complication and deformity recurrence which need follow-up after removal of the plate.
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Objective To retrospectively review long?term results of developmental dislocation of the hip patients treated with open reduction and Salter pelvic osteotomy, and to analyze the potential risk factors. Methods Sixty?eight developmental dislocation of the hip cases (81 hips) were treated with open reduction and Salter pelvic osteotomy from September 1992 to Octo?ber 2002, 45 cases (52 hips) were followed up to skeletal maturity. None had undergone other treatment before the key surgery. Some cases received skeleton traction before surgery. The radiographic and functional results were assessed at last follow?up. The possible relevant factors for unsatisfactory outcome were analyzed. The correlation between type ⅡAVN and the coverage rate of the femoral head were evaluated. Results The mean age at surgery was 2.5 years (ranged from 1.4 to 5.3 years). At last follow?up, 44 hips (84.6%) had excellent or good functional results. 23 hips (44.2%) had avascular necrosis of varying severity, of which 16 hips were typeⅡ. There was significant relevance between the AVN severity and the Severin classification result (P=0.018). Theover correctionhips, that were overcorrected during surgery, were more likely to get severe type AVN ( P=0.037). There was no correlation between TypeⅡAVN with uncoverage according to CE angle and Reimers index (P=0.457, 0.308 respectively). Con?clusion 1) Satisfactory functional and radiographic results could be expected in developmental dislocation of the hip cases with?out AVN;2) High risk of AVN existed in the late diagnosised hips that underwent open reduction and Salter pelvic osteotomy, typeⅡwas the most common type;3) TypeⅡAVN was not a predictor for progressive femoral head coverage deficiency;4)Over cor?rectionin Salter pelvic osteotomy was related with severe type AVN which should be avoided.
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Objective To evaluate the effect of greater trochanteric transfer for the treatment of coxa brevis in children and adolescents.Methods From August 2005 to January 2011,twenty patients (22 hips)with coxa brevis underwent greater trochanteric transfer.Among them 18 patients (20 hips) were available for evaluation,including 4 boys and 14 girls,with an average age of 11.4 years (range,7.5-15.0 years) at operation.Five cases (6 hips) were caused by Perthes disease,and 13 cases (14 hips) were caused by developmental dysplasia of hip.Four patients (4 hips) had undergone greater trochanteric epiphyseodesis ever before.All patients were fixed with tension screw after the deformity was corrected during the operation.After operation,the human plaster spica was used for 6 weeks in all patients.Results All patients were followed up for 14 to 79 months (average,31 months).At the last follow-up,fatigue or pain in the hips disappeared or improved in 13 patients.Sixteen patients had limping and positive Trendelenburg sign preoperatively,at the last follow-up 9 patients got improvement.Twelve patients (13 hips) had limitation of abduction of the hip,the average range of abduction was 25.38°±1.20°,which was improved to 45.38°±1.05° at the last follow-up.The average articulotrochanteric distance and ratio of the distance from the greater trochanter tip to femoral head center and the radius of the femoral head at the last follow-up was (17.47+3.14)mm and 2.10±0.21,respectively,there were statistical differences compared with those before operation [(-2.89±4.62) mm and 1.59±0.22,respectiovely].The average leg-length discrepancy at the last follow-up was (0.78t±0.26) cm,which had on statistical differences compared with that [(0.83 ±0.33) cm]before operation.Conclusion Greater trochanteric transfer for the treatment of coxa brevis in children and adolescents could improve the clinical symptom,recover the normal anatomy of the proximal femoral,restore the hip biomechanics environment,but could uot improve the leg-length discrepancy.
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Objective To evaluate the result of manipulative reduction and percutaneous cannulated screws fixation for the triplane fracture of the distal tibia in children. Methods From September 2004 to March 2009, 15 cases of triplane fracture of the distal tibia were treated with manipulative reduction and percutaneous cannulated screws fixation. This study included 9 boys with an average age of 13.2 years (range, 12-14 years) and 6 girls with an average age of 12.4 years (range, 11-14 years). Preoperative diagnoses were confirmed by the X-ray films or CT examination. If plain radiographs showed the fracture gap of epiphysis board and articular surface were greater than 2 mm after closed reduction, the operation was needed. Under "C"-arm X-ray machine, anatomical reduction was achieved by manipulative reduction according to the bone fracture type. The fractures were fixed by percutaneous cannulated screw. Postoperative CT scanning confirmed anatomical reduction. All patients had been immobilized with cast for 8 weeks. The ankle joint function and growth were evaluated by modified Weber protocol. Results All patients were followed up for 15 to 68 months with an average of 26 months. There were excellent in 13 cases, good in 2 cases. X-ray films showed all fractures were healed. There were not bone bridge and uneven articular surface, or rotating and shortening deformity. All patients could participate in the normal physical activities. The 2 cases with good outcome were related to weight-bearing too early. The main problem was that pain occurred in ankle joint with excess activity. Conclusion The method of manipulative reduction and percutaneous cannulated screw fixation is relatively reliable treatment for closed triplane fractures of the distal tibia.