Coppola C, Maffulli N
Department of Orthopaedic Surgery, University of Aberdeen Medical School, Scotland.
J R Coll Surg Edinb. 1999 Feb;44(1):46-54.
Limb shortening is an option to manage leg length discrepancy (LLD). Before skeletal maturity, a LLD between 2 and 5 cm can be corrected by epiphyseodesis (open or closed) or stapling. All these procedures require exact timing of surgery. In skeletally mature patients, shortening of the femur is considered safer than tibial shortening. Subtrochanteric and supracondylar osteotomies fixed with a blade-plate can be used to correct associated deformity. Mid-shaft shortening can be performed by a closed or open method. Closed shortening has been widely used, but frequent malrotation, loss of function and acute respiratory distress syndrome following reaming have been reported. Therefore, the use of a nail locked proximally and distally, and caution in reaming the canal, are strongly recommended. For LLDs greater than 10 cm, lengthening should be considered, although a one-stage two-limb procedure can be used, whereby shortening is performed on the longer limb, and the excised bone segment is implanted in the contralateral limb to be lengthened. However, when shortening procedures are performed in skeletally immature patients, they require precise timing, and indications and technical details must be strictly observed.
肢体短缩是处理下肢长度不等（LLD）的一种选择。在骨骼成熟之前，2至5厘米的下肢长度不等可通过骨骺阻滞术（开放或闭合）或骨骺钉固定术进行矫正。所有这些手术都需要精确的手术时机。在骨骼成熟的患者中，股骨短缩被认为比胫骨短缩更安全。用刀片钢板固定的转子下和髁上截骨术可用于矫正相关畸形。骨干中部短缩可通过闭合或开放方法进行。闭合短缩术已被广泛应用，但有报道称其常伴有旋转不良、功能丧失以及扩髓后出现急性呼吸窘迫综合征。因此，强烈建议使用远近端锁定的髓内钉，并在扩髓时谨慎操作。对于下肢长度不等大于10厘米的情况，应考虑肢体延长，尽管可以采用一期双下肢手术，即在较长的肢体上进行短缩，然后将切除的骨段植入对侧待延长的肢体。然而，在骨骼未成熟的患者中进行短缩手术时，需要精确的时机，并且必须严格遵守适应症和技术细节。
