Treatment of deformities in patients with healed congenital pseudarthrosis of the tibia
- 作者: Zakharjan E.A.1, Pozdeev A.P.1, Vilensky V.A.1
-
隶属关系:
- The Turner Scientific Research Institute for Children’s Orthopedics
- 期: 卷 6, 编号 4 (2018)
- 页面: 27-36
- 栏目: Original papers
- URL: https://bakhtiniada.ru/turner/article/view/10342
- DOI: https://doi.org/10.17816/PTORS6427-36
- ID: 10342
如何引用文章
详细
Background. Correction of deformities and lengthening of the lower extremities in patients with healed congenital pseudarthrosis of tibia (cCPT) is associated with certain characteristics, difficulties, and complications. But even the restoration of the anatomy and length of the tibia does not solve the problem of further recurrence of the deformity.
Aim. This study aimed to evaluate the results of the correction of deformities of the tibia in patients with congenital pseudarthrosis of the tibia after achieving union by using external fixation and guided growth.
Materials and methods. The results of treatment of 19 patients with cCPT, aged 4–15 years, which were observed in the Department of the Turner Scientific Research Institute from 2013 to 2018 years, were analyzed. We analyzed the types of deformities before the stage of correction deformities, evaluated the accuracy of the correction deformities after two-level osteotomies of the tibia, and used ortho-SUv passive computer navigation. External fixation index and number of complications were also determined. The type and number of recurrence of deformities and the timing of their detection were analyzed.
Results. On the basis of clinical classification, patients with cCPT had complex deformities of the affected lower limb. The accuracy of the correction of deformities was 84% at the end of the correction period. The amount of elongation was 4.5 ± 1.5 cm. The IEF was 64.3 ± 40.6 days/cm. After the end of the external fixation period, deformities recurred in 100% of cases. In 17 patients, temporary hemiepiphysiodesis of the tibial bones, the second stage, was performed. The accuracy of the correction was 100%. The period of correction ranged from 12 to 14 months.
Discussion. In the literature, we found no studies investigating the accuracy of the deformity correction, the choice of the level of osteotomies in patients with cCPT. Considering these data and the experience of the senior author of the publication, we performed two osteotomies of the tibia, outside the consolidation zone of the pseudarthrosis. High accuracy of the correction deformities was achieved in conjunction with the use of the ortho-SUv frame.
Conclusion. The analysis showed that the deformity relapsed in 100% of children as the child grows, regardless of the accuracy of the deformity correction in children after achieving union CPT. Hemiepiphysiodesis is an effective treatment for this complication.
作者简介
Ekaterina Zakharjan
The Turner Scientific Research Institute for Children’s Orthopedics
编辑信件的主要联系方式.
Email: zax-2008@mail.ru
ORCID iD: 0000-0001-6544-1657
SPIN 代码: 4851-9908
Scopus 作者 ID: 57193258044
Researcher ID: T-3072-2018
MD, PhD, Researcher of the Department of Bone Pathology
俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Alexander Pozdeev
The Turner Scientific Research Institute for Children’s Orthopedics
Email: prof.pozdeev@mail.ru
ORCID iD: 0000-0001-5665-6111
SPIN 代码: 3408-8570
Scopus 作者 ID: 6701438186
Researcher ID: T-6146-2018
MD, PhD, Professor, Chief Researcher of the Department of Bone Pathology
俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Victor Vilensky
The Turner Scientific Research Institute for Children’s Orthopedics
Email: vavilensky@mail.ru
ORCID iD: 0000-0002-2702-3021
SPIN 代码: 4001-9423
Scopus 作者 ID: 639529
MD, PhD, Senior Researcher of the Department of Bone Pathology
俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603参考
- Shah H, Doddabasappa SN, Joseph B. Congenital pseudarthrosis of the tibia treated with intramedullary rodding and cortical bone grafting: a follow-up study at skeletal maturity. J Pediatr Orthop. 2011;31(1):79-88. doi: 10.1097/BPO.0b013e318202c45d doi: 10.1097/BPO.0b013e318202c45.
- Pannier S, Pejin Z, Dana C, et al. Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: preliminary results of five cases. J Child Orthop. 2013;7(6):477-485. doi: 10.1007/s11832-013-0535-2.
- Thabet AM, Paley D, Kocaoglu M, et al. Periosteal grafting for congenital pseudarthrosis of the tibia: a preliminary report. Clin Orthop Relat Res. 2008;466(12):2981-2994. doi: 10.1007/s11999-008-0556-1.
- Borzunov DY, Chevardin AY, Mitrofanov AI. Management of congenital pseudarthrosis of the tibia with the Ilizarov method in a paediatric population: influence of aetiological factors. Int Orthop. 2016;40(2):331-339. doi: 10.1007/s00264-015-3029-7.
- Кутиков С.А., Борзунов Д.Ю., Дьячкова Г.В., и др. Лечение врожденного ложного сустава костей голени // Вестник хирургии имени И.И. Грекова. – 2016. – Т. 175. – № 4. – С. 53–58. [Kutikov SA, Borzunov DY, D’yachkova GV, Chevardin AY. Treatment of congenital pseudarthrosis of the tibia. Vestn Khir im I.I. Grek. 2016;175(4):53-58. (In Russ.)]
- Поздеев А.П. Ложные суставы и дефекты костей у детей (Этиология, клиника, лечение): Дис. … д-ра мед. наук. – СПб., 1998. [Pozdeev AP. Lozhnye sustavy i defekty kostey u detey (Etiologiya, klinika, lechenie). [dissertation] Saint Petersburg; 1998. (In Russ.)]
- Захарьян Е.А. Комплексное лечение деформаций нижней конечности у пациентов с врожденным ложным суставом костей голени: Дис. … канд. мед. наук. – СПб., 2017. [Zakhar’yan EA. Kompleksnoe lechenie deformatsiy nizhney konechnosti u patsientov s vrozhdennym lozhnym sustavom kostey goleni. [dissertation] Saint Peterburg; 2017. (In Russ.)]
- Cho TJ, Choi IH, Lee KS, et al. Proximal tibial lengthening by distraction osteogenesis in congenital pseudarthrosis of the tibia. J Pediatr Orthop. 2007;27(8):915-920. doi: 10.1097/bpo.0b013e31815a6058.
- Zhu GH, Mei HB, He RG, et al. Effect of distraction osteogenesis in patient with tibial shortening after initial union of Congenital Pseudarthrosis of the Tibia (CPT): a preliminary study. BMC Musculoskelet Disord. 2015;16:216. doi: 10.1186/s12891-015-0680-5.
- Choi IH, Cho TJ, Moon HJ. Ilizarov treatment of congenital pseudarthrosis of the tibia: a multi-targeted approach using the Ilizarov technique. Clin Orthop Surg. 2011;3(1):1-8. doi: 10.4055/cios.2011.3.1.1.
- Stevens PM. The role of guided growth as it relates to limb lengthening. J Child Orthop. 2016;10(6):479-486. doi: 10.1007/s11832-016-0779-8.
- Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop. 2007;27(3):253-259. doi: 10.1097/BPO.0b013e31803433a1.
- van Oosterbos M, van der Zwan AL, van der Woude HJ, Ham SJ. Correction of ankle valgus by hemiepiphysiodesis using the tension band principle in patients with multiple hereditary exostosis. J Child Orthop. 2016;10(3):267-273. doi: 10.1007/s11832-016-0742-8.
- Burghardt RD, Herzenberg JE. Temporary hemiepiphysiodesis with the eight-plate for angular deformities: mid-term results. J Orthop Sci. 2010;15(5):699-704. doi: 10.1007/s00776-010-1514-9.
- Danino B, Rodl R, Herzenberg JE, et al. Guided growth: preliminary results of a multinational study of 967 physes in 537 patients. J Child Orthop. 2018;12(1):91-96. doi: 10.1302/1863-2548.12.170050.
- Виленский В.А., Захарьян Е.А., Поздеев А.А., и др. Лечение детей с врожденными деформациями длинных костей нижних конечностей путем последовательного использования управляемого роста и чрескостного остеосинтеза (предварительное сообщение) // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2018. – Т. 6. – № 3. – С. 12–24. [Vilensky VA, Zakharyan EA, Pozdeev AA, et al. Treatment of congenital long-bone deformities in children using the consequtive application of guided growth and external fixation: preliminary report. Pediatric traumatology, orthopaedics and reconstructive surgery. 2018;6(3):12-24. (In Russ.)]. doi: 10.17816/PTORS6312-24.
- Paley D. Principles of deformity correction. Exercise Workbook. New York: Springer-Verlag; 2002.
- Normal lower limb alignment and joint orientation. Ed by D. Paley. Principles of Deformity Correction. Berlin, Germany: Springer-Verlag; 2005. P. 1-18.
- Виленский В.А., Поздеев А.А., Зубаиров Т.Ф., и др. Лечение детей с деформациями длинных трубчатых костей нижних конечностей методом чрескостного остеосинтеза с использованием аппарата Орто-СУВ: анализ 213 случаев // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2016. – Т. 4. – № 4. – С. 21–32. [Vilensky VA, Pozdeev AA, Zubairov TF, et al. Treatment of pediatric patients with lower extremity deformities using software-assisted Ortho-SUV Frame: analysis of 213 cases. Pediatric traumatology, orthopaedics and reconstructive surgery. 2016;4(4):21-32. (In Russ.)]. doi: 10.17816/PTORS4421-32.
- Соломин Л.Н., Щепкина Е.А., Виленский В.А., и др. Коррекция деформаций бедренной кости по Илизарову и основанным на компьютерной навигации аппаратом «Орто-СУВ» // Травматология и ортопедия России. – 2011. – № 3. – С. 32–39. [Solomin LN, Schepkina EA, Vilensky VA, et al. Correction of femur deformities by Ilizarov method and by apparatus Ortho-SUV based on computer navigation. Travmatologiia i ortopediia Rossii. 2011;(3):32-39. (In Russ.)]
- Скоромошко П.В. Оптимизация лечения больных с диафизарными деформациями бедренной кости на основе использования чрескостного аппарата со свойствами пассивной компьютерной навигации (экспериментально-клиническое исследование): Дис. … канд. мед. наук. – СПб., 2014. [Skoromoshko PV. Optimizatsiya lecheniya bol’nykh s diafizarnymi deformatsiyami bedrennoy kosti na osnove ispol’zovaniya chreskostnogo apparata so svoystvami passivnoy komp’yuternoy navigatsii (eksperemental’no-klinicheskoe issledovanie). [dissertation] Saint Petersburg; 2014. (In Russ.)]
- Определение референтных линий и углов длинных трубчатых костей: пособие для врачей. – СПб.: РНИИИТО им. Р.Р. Вредена, 2010. [Opredelenie referentnykh liniy i uglov dlinnykh trubchatykh kostey: posobie dlya vrachey. Saint Petersburg: RNIIITO im. R.R. Vredena; 2010. (In Russ.)]
- Соломин Л.Н., Виленский В.А. Практическая классификация деформаций длинных трубчатых костей // Травматология и ортопедия России. – 2008. – № 3. – С. 44. [Solomin LN, Vilenskiy VA. Prakticheskaya klassifikatsiya deformatsiy dlinnykh trubchatykh kostey. Travmatologiia i ortopediia Rossii. 2008;(3):44. (In Russ.)]
- Vargas Barreto B, Caton J, Merabet Z, et al. Complications of Ilizarov leg lengthening: a comparative study between patients with leg length discrepancy and short stature. Int Orthop. 2007;31(5):587-591. doi: 10.1007/s00264-006-0236-2.
- Inan M, El Rassi G, Riddle EC, Kumar SJ. Residual deformities following successful initial bone union in congenital pseudoarthrosis of the tibia. J Pediatr Orthop. 2006;26(3):393-399. doi: 10.1097/01.bpo.0000217716.64986.f0.
补充文件
