Efficacy of dynamic load during walking on the prediction of rebound effects following guiding growth intervention in children with angular deformities

步行动态负荷对角畸形儿童指导生长干预后反弹效应预测的效果

• 批准号: 403837822
• 负责人: Professor Dr. Harald Böhm
• 金额: --
• 依托单位: Klinik für Orthopädie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2018
• 资助国家: 德国
• 起止时间: 2017-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/403837822?language=en
• 关键词: Efficacy; dynamic; load; during; walking

Rationale: Malalignment of knee joints is predisposed to the development of unicompartmental degenerations because of the excessive load placed on one side of the knee. Therefore, guided growth in skeletally immature patients is recommended. However, a rebound effect (recurrence of the malalignment) after implant removal frequently occurs. Up to now, the reasons for this phenomenon are not well understood and standards for optimal timing for hardware removal do not exist. This timing is crucial for the long term success of the axial corrections. In addition, indication for hardware removal is based on static measures during standing that does not reflect the actual load situation and individual compensatory mechanisms during walking. Objectives: The aim of the study is to investigate the influence of the dynamic load during walking on the rebound effect following a guiding growth intervention using tension band plates. Methods: Gait analysis and standing radiographs will be captured the day before implantation and explantation of tension band plates. To analyse rebound effects, non-invasive gait analysis will be performed 6 and 12 months after explantation. To assess daily cumulative loadings mobile step trackers will be used. In order to predict the knee joint loading regime as a function of acting muscles, multi-body simulations will be applied and additionally compared with knee joint loading measures of gait analyses. Populations: 142 children with idiopathic varus or valgus leg malalignment and 60 typically developed age matched controls. Timeframe: The anticipated duration is 3 years. During the first six quarters patients and controls will be recruited. The expected time of axial correction through guiding growth is on average 12 month, the follow up time after removal is 6 and 12 months. Expected outcome: According to the current algorithm for hardware removal, which is based only on static measurements, a few patients may show a pathologic knee joint loading after explantation. Since the load situation affects bone remodelling, pathological loads may be related to higher rebound effects. The results of this study should give first time insights into the mechanical integrity of bones and muscles during and after guiding growth. This may improve the treatment algorithm.

基本原理：膝关节对线不良易于发生单髁退行性变，因为膝关节一侧承受的负荷过大。因此，建议在尿道未成熟患者中进行引导生长。然而，植入物取出后经常发生反弹效应（对线不良复发）。到目前为止，这种现象的原因还没有得到很好的理解，也不存在硬件拆除的最佳时机标准。这个时机对于轴向矫正的长期成功至关重要。此外，硬件移除的指示基于站立期间的静态测量，其不反映行走期间的实际负载情况和个体补偿机制。目的：本研究的目的是调查在步行过程中的动态负荷对反弹效果的影响，随后使用张力带板进行指导性生长干预。方法：在张力带钢板植入和复位前一天采集步态分析和站立位X线片。为了分析反弹效应，将在复位后6个月和12个月进行无创步态分析。为了评估每日累积负荷，将使用移动的步跟踪器。为了预测作为作用肌肉的函数的膝关节负荷状态，将应用多体模拟，并且另外将其与步态分析的膝关节负荷测量进行比较。人群：142名患有特发性内翻或外翻下肢对线不良的儿童和60名典型的年龄匹配对照。时间范围：预计持续时间为3年。在前六个季度，将招募患者和对照组。通过引导生长达到轴向矫正的预期时间平均为12个月，术后随访时间分别为6个月和12个月。 预期成果：根据目前的硬件移除算法，仅基于静态测量，少数患者可能在复位后显示病理性膝关节负荷。由于负荷情况影响骨重建，病理负荷可能与较高的反弹效应有关。这项研究的结果应该第一次深入了解骨骼和肌肉在指导生长期间和之后的机械完整性。这可以改进治疗算法。