The dissertation studies the problem of diagnosis and surgical treatment of
patients with Erlacher-Blount’s disease in different age periods and different stages of
the disease. Erlacher-Blount’s disease refers to a group of local physeal dysplasia, in
which distorted development of the medial area of the proximal growth plate of the
tibia with the formation of varus deformity is observed. According to the results of
clinical and radiological studies, it was found that the main clinical manifestations of
Erlacher-Blount’s disease is varus deformity of tibia bones with a violation of the
torsion component of the shin, which in turn leads to a disturbance in the biomechanics
of the entire lower limb. The most frequent and severe complication in the treatment
of Erlacher-Blount’s disease is relapse of the disease, which may occur up to 3-5 times
during the entire period of treatment until the end of the patient's growth. It has been
proven that due to inadequate diagnosis or inadequate treatment, Blount’s disease leads
to osteoarthrosis of a knee joint and disability of the patient.
The retrospective analysis of the results of Blount’s disease treatment conducted
on a significant clinical material (250 patients) found that the choice method of
treatment of early-onset form of Blount’s disease for children under the age of three is
a semi-circular periostomy that gives 98% positive results in this group of patients.
In the group of patients older than 3 years old the residual varus strain of the leg
is determined at the use of semicircular dissection of the periosteum. When applying
corrective osteotomy according to Shargorodsky in 25% of cases, with the patients
from 4 to 15 years old, there was a relapse of deformity requiring repeated surgical
treatment.
According to the data of the retrospective analysis, the structure of relapse of the
tibial varus deformity in Blount’s disease was analyzed and the criteria for prediction
of its relapses were determined on the basis of computer tomography data,
determination of skeletal maturity of knee bones, X-ray and morphometric
examination. It was proven that using exclusively minimal invasive surgical
interventions as semicircular dissection of the periosteum gives 98% positive results
among patients under 3 years old; minimally invasive treatment in combination with
blocking of growth plates and corrective osteotomies are used for the patients after 3
year-old age.
According to the clinical, radiological and biochemical methods of the study, a
comparative analysis of Erlacher-Blount’s disease and rickets was performed. The
evaluation of the obtained data on the peculiarities of the course of the abovementioned diseases makes it possible to predict the further development of orthopedic
manifestations, and to determine the necessity of surgical correction of varus
deformation of the lower extremities at those diseases similar at an early age.
The indications for operative treatment in Blount’s disease according to age,
skeletal maturity of the knee joint, degree of tibial deformity and stage of disease of
the patient have been developed. Blocking of overlying areas is subject to patients with
1-4 stages of deformity, 2-6 stages is according to Langensciold and skeletal maturity
of knee bones from 23 to 33 points. (The age of the patient is between 4-14 years old).
For patients with 1-2 stages of deformity, 1-2 stage for Langensciold and skeletal
maturity of the knee bones from 18 to 23 points (the age of the patient is 1-4 years old),
the semicircular dissection of the periosteum is recommended. For patients with 3-4 degree deformation, 5-6 stages according to Langensciold, with skeletal maturity of
30-33 points, corrective osteotomy of the shinbones in combination with temporary
blockage of the bulged areas is recommended. The age of the patient over 14 years old
when the knee joint growth plates are closed or are about to close, the presence of 2 or
more epiphyseal bridges on the inner third of the proximal growth area only the
corrective osteotomy of the tibia is recommended.
The performed analysis of the results of operative treatment showed that the
minimal percentage of complications in the form of relapse was obtained as a result of
minimally invasive surgical treatment such as semicircular dissection of the periosteum
(2%), blocking of growth plates (8%), combination of methods of blocking growth
plates and corrective osteotomy (12% the highest percentage of relapses was observed
with corrective osteotomies of the tibia (26%). Thus, at the timely diagnosis of the
disease and the use of minimally invasive surgical treatment, the lowest percentage of
complications in the form of relapses is observed during operative treatment of
Blount’s disease.
