临床小儿外科杂志2024，Vol.23Issue(11)：1009-1014,6.DOI:10.3760/cma.j.cn101785-202409048-002
导航下骺开放治疗儿童创伤性胫骨远端骺早闭所致踝内翻的影响因素分析
Analysis of factors influencing the navigated physeal bar resection for the treatment of ankle varus caused by traumatic premature physeal closure of the distal tibial physis in children
摘要
Abstract
Objective To analyze the clinical characteristics of navigated physeal bar resection(PBR)for ankle varus deformity caused by traumatic premature physeal closure of the distal tibial physis in children and to explore the factors influencing the success of the procedure.Methods A retrospective analysis was conducted on pediatric patients with traumatic premature physeal closure of the distal tibial physis resulting in ankle varus who underwent navigated PBR at the Department of Pediatric Orthopedics of Beijing Jishuitan Hos-pital,Capital Medical University,from June 2002 to October 2021.The clinical data analyzed included gender,age,injury mechanism,bone bridge morphology,time from injury to surgery,method of physeal blockage,osteot-omy approach,deformity correction time,and measurement of the lateral distal tibial angle(LDTA).Based on imaging data,patients were divided into successful and failed PBR groups.Patients were also grouped by growth potential,with boys over 12 and girls over 10 classified as having low growth potential.A multivariate logistic re-gression analysis was performed to identify factors influencing the success of the PBR.Results A total of 63 children were included in the study,with an average age of 9.1±2.5 years at the time of surgery and a follow-up period of 32.0(22.0,54.0)months.The time from injury to PBR was 18.0(13.0,28.0)months.There were 47 patients in the high-growth-potential group(30 boys,17 girls)and 16 in the low-growth-potential group(9 boys,7 girls).All patients underwent navigated PBR,with 25 cases receiving concurrent lateral distal tibial physeal blockage and 11 cases undergoing concurrent osteotomy.The preoperative LDTA was 108.1±5.5° in the successful group and 112.7±6.2° in the failed group,showing a statistically significant difference(t=-3.129,P=0.003).Multivariate logistic regression analysis indicated that growth potential(OR=15.122,95％CI:2.076-110.159,P=0.007)and preoperative LDTA(OR=0.855,95％CI:0.755-0.969,P=0.014)were independent factors influencing the success of PBR.Conclusions PBR for ankle varus deformity caused by traumatic premature physeal closure of the distal tibial physis in children is challenging.Growth po-tential is a critical factor affecting surgical outcomes.Careful patient selection,including accurate assessment of physeal function and growth potential,proper surgical planning,precise navigation-guided procedures,and close postoperative follow-up are key to surgical success.关键词
骺开放/骺早闭/踝内翻/生长潜力/外科手术/儿童Key words
Physeal Bar Resection/Premature Physeal Closure/Ankle Varus/Growth Potential/Surgi-cal Procedures,Operative/Child引用本文复制引用
徐雷,张宇辰,周达飞,董轶非,傅刚,鲁明..导航下骺开放治疗儿童创伤性胫骨远端骺早闭所致踝内翻的影响因素分析[J].临床小儿外科杂志,2024,23(11):1009-1014,6.基金项目
北京积水潭医院院级科研基金"天玑骨科手术机器人临床应用研究"项目(GCZX202203) Hospital-Level Research Fund Project of Beijing Jishuitan Hospital:"Clinical Application Research of Tianji Orthopedic Surgery Robot"Project(GCZX202203) （GCZX202203）
