Résumé
OBJECTIVE@#To discuss the long-term outcome of convex epiphysiodesis in the treatment for congenital scoliosis (CS).@*METHODS@#The clinical data of 22 patients with hemivertebral deformity undergoing convex epiphysiodesis from the October 1998 to Febuary 2008 were respectively analyzed. There were 12 males and 10 females. The whole spine anteroposterior radiographs were taken preoperatively, at 3-month postoperatively and at the final follow-up to measure the main curve and the compensatory curve. The progression rate was calculated for each patient. Observing the correlation between the progression rate and annual progression of the scoliosis and age, gender, hemivertebral number, hemivertebral position, preoperative main curve Cobb angle and compensatory curve Cobb angle, comparing different ages, genders, hemivertebral number and position, and preoperative main curve Cobb angle on the progression of postoperative curve.@*RESULTS@#The mean Cobb angle of main curve changed from (40.5±9.8) ° before surgery to (39.5±11.1) ° at 3 months after surgery, which significantly increased to (46.8±13.9) ° in the final follow-up. Meanwhile the mean Cobb angle of compensatory curve was changed from (20.1±10.8) ° before surgery to (23.0±11.1) °, which significantly increased to (29.9±11.5) ° in the final follow-up. There were no significant differences in the Cobb angle of the main curve and the compensatory curve between postoperative 3 months and before operation (>0.05). The difference between the final follow-up and the preoperative, postoperative 3 months was statistically significant (<0.01). Twenty patients experienced progression of both main curve and compensatory curve, with a mean progression rate of (19.2±17.9)% for main curve and (39.6±37.0)% for compensatory curve. The annual progression volume was (1.5± 1.4) ° for main curve and (1.4±1.3) ° for compensatory curve. Three patients underwent lateral convex orthopedic internal fixation due to postoperative scoliosis progression. The curve progression was significantly correlated with age at the time of surgery and hemivertebral number. There was a significant correlation between the age of the operation, the main curve angle, the preoperative compensatory curve angle and the annual progression volume of the main curve (<0.05).@*CONCLUSION@#The convex epiphysiodesis technique cannot effectively prevent curve progression of CS patients in the long-term follow-up. It is not recommended to apply this technique to the treatment of patients with congenital hemivertebrae.
Résumé
BACKGROUND: The ROM technique has been widely used to determine the rotational alignment of tibial prosthesis in total knee arthroplasty, but the accuracy of this technique remains controversial. However, there is no report on the influencing factors of ROM technique. OBJECTIVE: To explore the influencing factors of ROM technique in determining the rotational alignment of tibial prosthesis in total knee arthroplasty. METHODS: Totally 61 patients underwent unilateral knee arthroplasty, including 18 males and 43 females, aged between 55 and 78 years. All patients were diagnosed as knee osteoarthritis before operation. All operations were performed with the posterior cruciate-stabilizing total knee prostheses. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The rotational orientation of the tibial prosthesis was determined by the ROM technique with closed and unclosed medial retinaculum. A line from the center of the posterior cruciate ligament to the medial border of the patellar tendon was used as the anteroposterior axis of tibia (Akagi line). The angles between the anteroposterior axis of tibia and lines determined by the ROM technique were measured to identify the classification of patellar track so as to decide whether the classification of patellar track, closing and unclosing medial retinaculum are the influencing factors of ROM technology. RESULTS AND CONCLUSION: (1) The angles between the Akagi line and lines determined by the ROM technique respectively were (0.5±2.5)°, (-0.9±2.6)°, and (-3.9±3.4)° for the unclosed medial retinaculum and (0.6±2.3)°, (-0.3±2.2)°, and (-1.5±2.9)° for the closed medial retinaculum. (2) For type III patellar track, the angle between line determined by the ROM and Akagi line was significantly internal rotation compared with type I and type II patellar track (P 0.05). For type III patellar track, closing the medial retinaculum could significantly reduce the difference between Akagi line and the line determined by ROM technology (P < 0.05). (4) These results indicate that for type I and type II patellar track, ROM technique can accurately locate the rotational alignment of tibial prosthesis in total knee arthroplasty, and closing or unclosing the medial retinaculum will not affect the accuracy of the results. As to type III patellar track, whether or not the medial retinaculum is closed may lead to failure in determining the rotation alignment of the tibial prosthesis.