预测膝外翻畸形张力带钢板引导生长后反弹的隔离因素。

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2023-07-11 eCollection Date: 2023-10-01 DOI:10.1177/18632521231182432
Alexander Eberle, Anika Stephan, Matthias P Tedeus, Hans M Manner, Hannes A Rüdiger, Vincent A Stadelmann
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引用次数: 0

摘要

目的:对导致半骨骺切除术后生长反弹的条件仍知之甚少。本文分析了在特发性膝外翻患者中使用张力带钢板引导生长后的放射学结果,并试图建立生长反弹的预测模型。方法:选择接受张力带钢板治疗的特发性膝外翻畸形患者进行评估。我们只分析了冠状面畸形。本研究仅考虑在张力带钢板手术前进行长期X光检查的患者、在移除张力带钢板时进行长期X射线检查的患者以及在移除张力带钢板后最新随访时进行长期X线检查的患者。评估张力带镀层去除和最后一次随访之间机械轴偏差的变化是否存在反弹,并进行有序逻辑回归以确定预测反弹生长建模的相关变量。结果:总共分析了100名患者(189条腿)。张力带镀层去除时的平均机械轴偏差为8.4 内翻方向的平均机械轴偏差为-3.4 毫米(p ≤ 0.001)。然而,111条腿(59%)出现反弹增长,57条腿(30%)保持稳定,21条腿(11%)出现持续矫正。分离出六个显著影响回弹的临床相关因素:性别、年龄、基线机械轴偏移、机械股骨远端外侧角和机械胫骨近端内侧角,以及机械轴偏移校正率。机械轴偏差校正率的比值比最高。根据研究数据建立的用于预测反弹增长的机器学习分类模型显示出39%的错误分类率。结论:该队列中的反弹增长率很高,尤其是对于植入时年龄较小的患者。反弹生长的最高风险因素是男性,校正率高,比如在生长高峰期。所提出的分类模型需要更多的数据来提高其预测能力,然后才能用于临床。证据级别:三级。
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Isolating factors for the prediction of rebound after guided growth with tension band plating for the valgus deformity of the knee.

Purpose: The conditions leading to growth rebound after hemiepiphysiodesis are still poorly understood. This article analyzes the radiographical outcomes after guided growth with tension band plating, using plates in idiopathic genu valgum patients and attempts to generate a predictive model of growth rebound.

Methods: Patients with idiopathic genu valgum deformity who received tension band plating were selected for evaluation. We only analyzed coronal plane deformities. Only patients with a long-standing X-ray before tension band plating surgery, a long-standing X-ray at tension band plating removal, and a long-standing X-ray at the latest follow-up after tension band plating removal were considered for this study. The change of mechanical axis deviation between the tension band plating removal and the last follow-up was evaluated for rebound, and ordinal logistic regression was performed to determine the relevant variables for predictive modeling rebound growth.

Results: Overall, 100 patients (189 legs) were analyzed. The mean mechanical axis deviation at tension band plating removal was 8.4 mm in varus direction, and the mean mechanical axis deviation at the last follow-up was -3.4 mm (p ≤ 0.001). However, 111 legs (59%) showed rebound growth, 57 (30%) stayed stable, and 21 (11%) showed a continuous correction. Six significant factors significantly influencing rebound were isolated which are clinically relevant: sex, age, baseline mechanical axis deviation, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle, and mechanical axis deviation correction rate. Mechanical axis deviation correction rate had the highest odds ratios. The machine learning classification model for predicting rebound growth built from the study data showed a misclassification rate of 39%.

Conclusion: There was a high rate of rebound growth in this cohort, especially for patients at a young age at implantation. The highest risk factors for rebound growth were male sex, and high correction rates, such as found during peak growth spurt. The proposed classification model needs more data to improve its predictive power before it can be used in clinics.

Level of evidence: Level III.

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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
期刊介绍: Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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