3+4+Supplementum/2012 - Společnost pro pojivové tkáně

PROSPeCTiVe ORiGinal PaPeR
POSSiBiliTieS Of ePiPHY-
SiOdeSiS. PROMiSinG a new
deViCe Called THe eiGHT-
PlaTe Guided GROwTH SYSTeM
S. Petrasova 1, 2) , D. Zemkova1, 3) , I. Marik 1) , R.
Myslivec 1,4)
1) Ambulant Centre for Defects of Locomotor
Apparatus; Prague; Czech Republic
2) Dept. of Anthropology and Human Genetics;
Charles University; Prague; Czech Republic
3) Dept. of Paediatrics; University Hospital Motol;
Prague; Czech Republic
4) Orthopaedic and Traumatology Department,
Hospital Pribram, Czech Republic
keywords: epiphysiodesis; deformity
correction; limb length discrepancy;
anthropometry; remaining growth; eight-
Plate guided Growth System
introduction
We have many years ongoing experience
with orthopaedic treatment of biomechanically
serious limb deformities and
cases with uneven leg length. Traditionally,
angular deformities can be treated by
means of corrective osteotomy and application
of internal or external fixation. These
procedures are used in patients who are
skeletally mature and when the growth
epiphyses are closed. Osteotomy is necessary
for rotational correction, or when we
need the correction in more planes and/
or limb lengthening is indicated. Angular
correction or moderate length inhibition
may be achieved by other, less invasive
surgical methods called epiphysiodesis or
partial epiphysiodesis or temporary hemiepiphysiodesis
(so-called methods of “guided
growth”). Epiphysiodesis is paediatric
ambul_centrum@volny.cz
surgical procedure used to close a growth
plate. Total epiphysiodesis is indicated in
children with one leg longer than the
other. This disorder is referred to as limb
length discrepancy (LLD). Epiphysiodesis
is performed on the unaffected extremity
in scheduled time in order to prevent
a limb length discrepancy at the end
of growth period. Partial epiphysiodesis
(hemiepiphysiodesis) is used in cases of
valgosity or varosity (15). The aim of this
surgery is stop an abnormal growth on one
side of the epiphysis and correct an angulation
in the level of growth plate.
Several techniques of epiphysiodesis
have been evolved, enabling gradual correction
of angular deformity and/or leg
length equalisation.
The first surgical technique of open
epiphysiodesis was described by Phemister
in 1933. Rotation of bone blocks at both
sides of the growth plate together with
curettage causes unite of the physis (16).
Blount and Clarke developed epiphyseal
stapling in 1949. They described a staple
for hemiepiphyseal arrest (2). Many other
procedures attempting to guide epiphyseal
growth have been discussed and published.
Epiphysiodesis are ranked with noninvasive
surgical procedures but there
are also some pitfalls and complications.
Surgical planning for the precise
placement of the staples is complicated.
Epiphyseal stapling has disadvantages and
limitations because of staples. When rigid
staples are affected by the powerful forces
generated by growth of physis, the staples
can migrate, break or extruze (4). These
complications can lead to inadequate
correction or overcorrection of the axial
deformity or length discrepancies due to
premature unit of physis.
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