Aim. To retrospectively assess treatment outcomes of long bone deformities of the lower extremities accompanied by shortening in pediatric patients using a software-assisted Ortho-SUV Frame.Materials and methods. The accuracy of deformity correction (AC), period of deformity correction (PDC), external fixation index (EFI), and number of complications in 213 patients were retrospectively analyzed.Results. According to different parameters, AC of femur deformity correction (group 1) varied from 90% to 96%. The average length increase was 47 ± 12 mm. The average distraction duration was 38 ± 14 days. The average PDC was 8 ± 6 days for simple deformities (SDs), 14 ± 7 days for moderate deformities (MDs), and 23 ± 12 days for complex deformities (CDs). EFI was 26 ± 8 days/cm for SDs, 31 ± 6 days/cm for MDs, and 35 ± 12 days/cm for CDs. According to different parameters, AC of the lower leg deformity correction (group 2) varied from 89% to 95%. The average length increase was 52 ± 20 mm. The average distraction duration was 45 ± 18 days. PDC was 11 ± 5 days for SDs, 16 ± 9 days for MDs, and 27 ± 16 days for CDs. EFI was 32 ± 14 days/cm for SDs, 42 ± 12 days/cm for MDs, and 49 ± 8 days/cm for CDs. There were 48 (50.5%) complications in group I with the majority (71%) classified as Caton grade I and 29% as grade II. There were 62 (45%) complications in group 2, where 50% were Caton grade I and 50% were Caton grade II. There were no serious complications (Caton grade III) in either group that influenced the final functional results.Conclusion: Use of a software-assisted Ortho-SUV Frame increased the efficiency of treatment of pediatric patients with long bone deformities because of the great accuracy of deformity correction.
Aim. This study aimed to estimate the results of congenital long bone deformities using the consecutive application of guided growth and external fixation. Materials and methods. We performed a retrospective analysis of the treatment results of 38 children with congenital deformities of long bones. Group 1 consisted of 17 children who underwent consecutive application of two methods: guided growth and external fixation. Group 2 (control group) consisted of 21 children who underwent isolated lengthening and deformity correction by external fixation. Results. There were 14 complications in group 1 and 25 complications in group 2. Moreover, only seven cases in group 1 had complications requiring surgical treatment, whereas 17 cases in group 2 required operative treatment for complications. There was a relatively low level of refractures: zero cases in group 1 and three cases in group 2. The most common complication was a recurrence of deformity associated with the continuous growth of children: seven cases in group 1 and eight cases in group 2. However, no recurrence of the torsion component of deformity was observed in any group 1 cases, and repeated guided growth could be performed in the six cases of growing children. Conclusion. The consecutive use of external fixation and guided growth to treat congenital deformities of the lower limbs is a promising direction for pediatric orthopedics because it reduces the incidence of complications. The repeated use of guided growth, because of its minimal invasiveness, is the most effective solution for the recurrence of deformity in a growing child.
Цель работы -ретроспективно проанализировать результаты двух методов лечения детей с деформациями голени, являющимися следствием парциального синостоза зоны роста. Материалы и методы. Группу I составили 15 пациентов, которым выполняли остеотомию с одномоментной гиперкоррекцией деформации и чрескостный остеосинтез аппаратом Илизарова с последующим дозирован-ным удлинением сегмента. Группу II составили 13 пациентов, которым выполняли гемиэпифизиодез функцио-нирующей порции поврежденной зоны роста, остеотомию, чрескостный остеосинтез аппаратом Орто-СУВ с последующей коррекцией деформации и удлинением сегмента во времени. Результаты. В группе I выявлено, что при коррекции варусных деформаций гиперкоррекция по девиации ме-ханической оси (ДМО) составила 18,28 ± 5,25 мм, гиперкоррекция по мМПрББУ (механическому медиальному проксимальному большеберцовому углу) -14,86 ± 4,45°; по мЛДББУ (механическому латеральному больше-берцовому углу) -12,85 ± 3,02°. При коррекции вальгусных деформаций гиперкоррекция по ДМО составила 15,12 ± 8,28 мм, гиперкоррекция по мМПрББУ -10,38 ± 2,77°; по мЛДББУ -7,5 ± 3,9°. В 11 случаях (73 %) отмечался рецидив деформации. При этом минимальные сроки рецидива деформации составили 5 месяцев, максимальные -16 месяцев. В группе II точность коррекции (ТК) варусных деформаций по ДМО составила 98 %, по мМПрББУ и мЛДББУ -94 %; для вальгусных деформаций по ДМО -90 %, по мМПрББУ и мЛДББУ -96 %. ТК антекурвационных дефор-маций по анатомическому заднему проксимальному большеберцовому углу (аЗПББУ) и анатомическому переднему дистальному большеберцовому углу (аПДББУ) составила 96 %, рекурвационных -92 %. Только в одном случае через 6 месяцев после демонтажа аппарата отмечался рецидив деформации. В 2 случаях по мере роста ребенка по-требовалось повторное оперативное вмешательство, направленное на устранение неравенства длин конечностей. Заключение. Использование методики эпифизиодеза неповрежденной порции зоны роста в сочетании с остео-томией и чрескостным остеосинтезом на базе компьютерной навигации с последующими дозированными коррекцией деформации и удлинением достоверно снижает частоту рецидивов у пациентов с деформациями голени на фоне физарных синостозов.Ключевые слова: эпифизиодез; компьютерная навигация; гексапод; аппарат Орто-СУВ; коррекция деформа-ции; гиперкоррекция. TREATMENT OF PEDIATRIC PATIENTS WITH LOWER LEG DEFORMITIES ASSOCIATED WITH PHYSEAL ARREST: ANALYSIS OF 28 CASES
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.
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