Removal of the Metaphyseal Screw From Tension Band Constructs After Hemiepiphysiodesis: High Rates of Physeal Tethering and Subsequent Implant Removal.

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-10-10 DOI:10.1097/BPO.0000000000002843
Timothy W Torrez, Michael Amick, Ndidi Njoku, Emily Zhang, Senah E Stephens, Christopher A Makarewich
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Abstract

Background: Removal of the metaphyseal screw from tension band plate constructs after correction of angular deformity in patients treated with hemiepiphysiodesis has been suggested as an alternative to removing the plate and both screws. While this has the potential benefit of easier implant removal and reinsertion in the event of rebound, there is debate in the literature regarding the benefits and risks of leaving the epiphyseal screw and plate in place.

Methods: Patients treated with hemiepiphysiodesis at the distal femur and/or proximal tibia with tension band plates and screws who underwent subsequent removal of the metaphyseal screw after correction were included. Charts and radiographs were reviewed for the need for metaphyseal screw reinsertion, subsequent removal of deep implants, and evidence of physeal tethering. Tethering was defined as progressive overcorrection in the treated bone segment after removal of the metaphyseal screw with the mechanical axis moving one full mechanical axis zone or more. Patients with tethering were compared with those without.

Results: A total of 215 patients with 387 limbs treated met inclusion criteria. Of those, 175 patients were treated for idiopathic genu valgum, while 40 were treated for other conditions. Fifty-nine individuals (27%) underwent replacement of the metaphyseal screw for repeat angular correction. Fifty-one percent of patients underwent secondary procedures for reasons other than metaphyseal screw reinsertion (74 symptomatic implant removal, 7 elective implant removal, 29 due to tethering). There were 44 cases of tethering in 36 patients (17%). In cases of tethering, 7 patients were treated with observation, 11 with implant removal only, 16 with hemiepiphysiodesis on the opposite side, and 2 with osteotomy. Patients with tethering were significantly younger, more likely to be male, and more likely to have had the metaphyseal screw removed more than once (P < 0.05).

Conclusion: Removal of only the metaphyseal screw after hemiepiphysiodesis has high rates of tethering and further surgery for iatrogenic deformity correction and implant removal. This technique is not recommended.

Level of evidence: Therapeutic Level III, case-control study.

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半骺成形术后从张力带结构中取出骺螺钉:骨拴和随后植入物取出率很高。
背景:有人建议,在半骺板切除术治疗患者的角度畸形矫正后,将骺螺钉从张力带钢板结构中移除,作为移除钢板和两根螺钉的替代方案。虽然这样做的潜在好处是在发生反弹时更容易取出和重新植入植入物,但文献中对保留骺螺钉和钢板的益处和风险存在争议:方法:纳入股骨远端和/或胫骨近端使用张力带钢板和螺钉进行半骺板固定术治疗的患者,这些患者在矫正后都进行了骺板螺钉的移除。对病历和X光片进行审查,以确定是否需要重新植入骺螺钉、是否需要随后移除深部植入物以及是否存在趾骨拴系的证据。拴系的定义是移除骺螺钉后,治疗骨段进行性过度矫正,机械轴移动一个完整机械轴区或更多。将有拴系的患者与没有拴系的患者进行比较:共有 215 名患者的 387 条肢体符合纳入标准。其中,175名患者接受了特发性膝外翻治疗,40名患者接受了其他疾病治疗。59人(27%)接受了骺螺钉置换术,以重复矫正角度。51%的患者因骺螺钉重新植入以外的原因接受了二次手术(74例症状性植入物移除,7例选择性植入物移除,29例因系带绑扎)。36名患者中有44例(17%)发生了拴系。在拴系病例中,7名患者接受了观察治疗,11名患者仅移除了植入物,16名患者在对侧进行了半椎体切除术,2名患者进行了截骨术。拴系的患者明显更年轻,更可能是男性,更可能曾多次取出骺螺钉(P < 0.05):结论:在半骺成形术后仅取出骺螺钉会导致较高的系带率,并需要进一步手术进行先天性畸形矫正和植入物取出。不建议采用这种技术:治疗III级,病例对照研究。
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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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