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

At present, we provided temporary
hemi-epiphysiodesis by eight plate system at
3 patients with hypophosphatemic rickets.
Results
Partial permanent hemi-epiphysiodesis
was made in a cohort of 51 patients (22
girls, 29 boys) aged 10.4 – 16.5 years. Total
of 60 epiphysiodesis surgeries has been
done. Medial or lateral hemiepiphysiodesis
(deformity correction in a frontal plane)
was done in 42 patients, and ventral hemiepiphysiodesis
of distal femur (correction of
flexion deformity in a sagittal plane) was
carried out in a cohort of 13 patients.
Medial or lateral epiphysiodesis was
made in the average age 13.2 ± 1.31 years
(12.53 ± 1.23 years in girl, 13.84 ± 1.06
years in boys). Before surgery average
intermaleollar distance was 8.04 ± 2.47 cm
(range 4 cm–14.5 cm). The evaluation
showed that intermaleolar distance was
decreased to 1.36 ± 1.42 cm by surgical
treatment. Tibiofemoral angel was normalized
to physiological values from 10.7 ± 7.9°
(range from –15° till 25°) to 5.04 ± 1.62°
(range from 3° till 8°).
We indicate ventral hemiepiphysiodesis
of the distal epiphyseal plate of femur in
flexion knee deformities/contractures (e.g.
popliteal pterygeal syndrome, arthrogryposis
congenita multiplex, cerebral palsy,
etc.). The first results of ventral hemiepiphysiodesis
are encouraging. Ventral
epiphysiodesis was made in the average
age 13.64 ± 1.25 years (range 11.49–15.41
years).
Results of total permanent epiphysiodesis:
45 patients underwent treatment
for leg length discrepancy, 47 epiphysiodeses
were carried out. The final shortening
ranged between 0–3.0 cm, median of final
ambul_centrum@volny.cz
shortening was 1.0 cm. The average age at
the time of total epiphysiodesis was 12.35
± 0.91 years (median 12.31 years) for girls
and for boys 13.9 ± 1.28 years (median
13.87 years). This corresponds to bone
age 12.54 ± 0.7 years (median 12.6 years)
for girls and for boys 13.76 ± 1.16 years
(median 13.65 years).
The values are diminished from the
average original predicted limb discrepancy
2.87 ± 1.34 cm (min. 1.3 cm, max. 7.0 cm,
median 2.5 cm).
Conclusion
The hemiepiphysiodeses or total epiphysiodesis
(in frontal and/or sagittal
plane) are the method of choice for correction
of the angular deformities around
the knee and in surgical treatment of limb
length discrepancy. Anthropometry is
a necessary tool for prediction of remaining
growth of extremities, indication and
timing of epiphysiodesis. The exact assessment
of bone age, sexual maturity and
anthropometric tibiofemoral angle evaluation
are the main prerequisites for right
timing of this surgical procedure.
Our contribution summarizes experience
with epiphysiodesis by modified
Macnicol methods, with growth of the
lower extremity and timing of the surgery.
As a new method of choice there is
recommended epiphysiodesis using the
Orthofix eight-Plate System (or Guided
Growth Plate) which we started to use
now. The figure-eight shaped device
(2-hole plate and screws) about the size of
a paper clip allows gradual correction of
child’s periarticular limb deformity and/or
discrepancy of leg length. Extraperiosteal
2-hole plate and screws seems to be the
appropriate method especially in the bone
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