Konzepte zur Analyse und Korrektur von Beinachsenfehlern

Zusammenfassung

Die Behandlung unterschiedlich langer und krummer Beine zählt zu den grundlegenden Aufgaben der Kinderorthopädie. Während im Wachstumsalter häufig das Potenzial der Epiphysenfugen zum Ausgleich von Beinlängendifferenzen und gelenknahen Achsendeformitäten durch Epiphysiodese genutzt werden kann, sind beim ausgewachsenen Patienten oder bei diaphysären Fehlstellungen zur Korrektur meist aufwendige und invasive operative Eingriffe erforderlich. Dazu stehen klassische Methoden zur Verfügung wie die adhoc-Korrektur durch Platten- bzw. Schrau -benosteosynthese oder die Fixateur-kontrollierten Methoden zur Kallusdistraktion, deren technische Möglichkeiten durch moderne Implantate wie Hexapodringfixateure, aber auch eine wachsende Zahl an Verlängerungsmarknägeln stark erweitert wurden.

Summary

Leg length discrepancies and leg deformities are common treatment tasks for pediatric orthopaedic surgeons. The potential of the growth plate can be used only during childhood and adolescence, when partial or complete epiphysiodesis can correct lenth discrepancies and deformities. After maturity or in case of diaphyseal deformities, complex and often invasive surgery is needed for correction. A variety of different methods such as one-step procedures with internal fixation devices or distraction osteogenesis guided by external fixators can be used. Advanced implants such as hexapod frames and a growing number of intramedullary distraction nails have considerably improved the technical capabilities.

Schlüsselwörter

Epiphyseodese - Deformitätenkorrektur - Beinlängendifferenz - Beinachsendeformität

Keywords

Epiphysiodesis - leg length discrepancy - lower-limb deformity - deformity correction

• Literatur

• 1 Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine 1983; 8: 643-651.
• 2 Grundy PF, Roberts CJ. Does unequal leg length cause back pain? A case-control study. Lancet 1984; 2: 256-258.
• 3 Do TT. Clinical and radiographic evaluation of bowlegs. Current opinion in pediatrics 2001; 13: 42-46.
• 4 Wilkins KE. Bowlegs. Pediatric clinics of North America 1986; 33: 1429-1438.
• 5 Heath CH, Staheli LT. Normal limits of knee angle in white children - genu varum and genu valgum. Journal of pediatric orthopedics 1993; 13: 259-262.
• 6 Salenius P, Vankka E. The development of the tibiofemoral angle in children. The Journal of bone and joint surgery American volume 1975; 57: 259-261.
• 7 Westhoff B, Jager M, Krauspe R. Axes of the legs in childhood. What is pathologic?. Der Orthopade 2007; 36: 485-498. quiz 99-500.
• 8 Chapple CM, Nicholson H, Baxter GD, Abbott JH. Patient characteristics that predict progression of knee osteoarthritis: a systematic review of prognostic studies. Arthritis care & research 2011; 63: 1115-1125.
• 9 Moraal JM, Elzinga-Plomp A, Jongmans MJ. et al. Long-term psychosocial functioning after Ilizarov limb lengthening during childhood. Acta orthopaedica 2009; 80: 704-710.
• 10 Paley D. Correction of limb deformities in the 21st century. Journal of pediatric orthopedics 2000; 20: 279-281.
• 11 Keppler P, Strecker W, Kinzl L. Analysis of leg geometry--standard techniques and normal values. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizin 1998; 69: 1141-1152.
• 12 Ganger R, Grill F, Lehner A, Kotb H. [Cogenital femoral defect. Indication, therapy and complication management]. Der Orthopade 1999; 28: 1045-1057.
• 13 Westhoff B, Wild A, Krauspe R. Development of the leg axis in childhood and treatment options for deformities near the knee joint. Der Orthopade 2002; 31: 1198-1208. quiz 208-209.
• 14 Schneider B, Laubenberger J, Jemlich S. et al. Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging. The British journal of radiology 1997; 70: 575-579.
• 15 Paley D, Pfeil J. Principles of deformity correction around the knee. Der Orthopade 2000; 29: 18-38.
• 16 Guenther KP, Tomczak R, Kessler S. et al. Measurement of femoral anteversion by magnetic resonance imaging - evaluation of a new technique in children and adolescents. European journal of radiology 1995; 21: 47-52.
• 17 Thiemann H-H, Nitz I. Röntgenatlas der normalen Hand im Kindesalter. Leipzig: Thieme; 1991
• 18 Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. Stanford, CA: Stanford University Press; 1959
• 19 Tanner JM, Whitehouse RH, Marshall WA. et al. Assessment of skeletal maturity and prediction of adult height (TW2 method). London: Academic; 1975
• 20 Horter MJ, Friesen S, Wacker S. et al. Determination of skeletal age: comparison of the methods of Greulich and Pyle and Tanner and Whitehouse. Der Orthopade 2012; 41: 966-96.
• 21 Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clinical orthopaedics and related research. 1990: 81-104.
• 22 Paley D. Current techniques of limb lengthening. Journal of pediatric orthopedics 1988; 8: 73-92.
• 23 Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clinical orthopaedics and related research. 1992: 48-64.
• 24 Exner GU. Normalwerte in Wachstum und Entwicklung. Stuttgart: Thieme; 1990: 156
• 25 Paley D, Bhave A, Herzenberg JE, Bowen JR. Multiplier method for predicting limb-length discrepancy. The Journal of bone and joint surgery American volume 2000; 82-A: 1432-1446.
• 26 Anderson M, Green WT, Messner MB. Growth and predictions of growth in the lower extremities. The Journal of bone and joint surgery American volume 1963; 45-A: 1-14.
• 27 Menelaus MB. Correction of leg length discrepancy by epiphysial arrest. The Journal of bone and joint surgery British volume 1966; 48: 336-339.
• 28 Moseley CF. A straight-line graph for leg-length discrepancies. The Journal of bone and joint surgery American volume 1977; 59: 174-179.
• 29 Canale ST, Christian CA. Techniques for epiphysiodesis about the knee. Clinical orthopaedics and related research. 1990: 81-85.
• 30 Phemister D. Operative Arrestment of longitudinal growth of bone in the treatment of deformities. The Journal of bone and joint surgery American volume 1933; 15: 1-15.
• 31 Blount WP, Clarke GR. Control of bone growth by epiphyseal stapling; a preliminary report. The Journal of bone and joint surgery American volume 1949; 31-A: 464-478.
• 32 Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. Journal of pediatric orthopedics 2007; 27: 253-259.
• 33 Gorman TM, Vanderwerff R, Pond M. et al. Mechanical axis following staple epiphysiodesis for limb-length inequality. The Journal of bone and joint surgery American volume 2009; 91: 2430-2439.
• 34 Raab P, Wild A, Seller K, Krauspe R. Correction of length discrepancies and angular deformities of the leg by Blount’s epiphyseal stapling. European journal of pediatrics 2001; 160: 668-674.
• 35 Hefti F. Deviations in the axes of the lower extremities. Der Orthopade 2000; 29: 814-820.
• 36 Corell J. Die Gliedmaßenverlängerung beim Kleinwuchs. Der Orthopade 2000; 787-794.
• 37 Hefti F. Malformations of the lower extremities. Der Orthopade 2008; 37: 381-402.
• 38 Rodl R, Leidinger B, Bohm A, Winkelmann W. Correction of deformities with conventional and hexapod frames - comparison of methods. Zeitschrift fur Orthopadie und ihre Grenzgebiete 2003; 141: 92-98.
• 39 Schiedel F, Rodl R. Lower limb lengthening in patients with disproportionate short stature with achondroplasia: a systematic review of the last 20 years. Disability and rehabilitation 2012; 34: 982-987.
• 40 Naqui SZ, Thiryayi W, Foster A. et al. Correction of simple and complex pediatric deformities using the Taylor-Spatial Frame. Journal of pediatric orthopedics 2008; 28: 640-647.
• 41 Camathias C, Valderrabano V, Oberli H. Routine pin tract care in external fixation is unnecessary: a randomised, prospective, blinded controlled study. Injury 2012; 43: 1969-1973.
• 42 Baumgart R, Zeiler C, Kettler M. et al. Fully implantable intramedullary distraction nail in shortening deformity and bone defects. Spectrum of indications. Der Orthopade 1999; 28: 1058-1065.