Koczewski P, Shadi M, Napiontek M, Marciniak W
Katedra i Klinika Ortopedii Dzieciecej, Akademia Medyczna im. K. Marcinkowskiego w Poznaniu.
Chir Narzadow Ruchu Ortop Pol. 2000;65(3):277-86.
The results of femoral lengthening using the Italian modification of the Ilizarov are presented. Mean age of the patients was 14 years (ranging from 7 to 29). The most frequent etiology of limb shortening was femoral hypoplasia (7 patients) and sequelae of septic arthritis of the hip and/or the knee (6 patients). Indications for surgical treatment were limb shortening from 3 to 12 cm (mean 6.5 cm), along with axial deviation ranging from 10 degrees to 40 degrees in 6 patients. Mean follow-up time was 15 months (ranging from 6 to 35 months). The Ilizarov apparatus was based on two distal rings, stabilized by "K" wires, and proximally by a ring connected with an Italian femoral arch, stabilized by a Schanz screw. Planned lengthening (ranging from 3.5 cm to 12 cm) was achieved in all treated patients. The healing index ranged from 0.8 to 2.1 month/cm (mean 1.4). Problems, obstacles and complications were analyzed according to the Paley classification. In all 16 patients without primary knee stabilization, limited knee flexion ranging from 5 degrees to 90 degrees (mean 40 degrees) was noted during the distraction phase, which didn't improve significantly during the consolidation phase. Knee flexion improved to a mean 90 degrees after a 6 month follow-up. Bone regenerate defects (cysts, narrowing) were noted in 4 patients. Secondary knee stabilization was performed in 2 cases. In the first case because of knee pain and a severe limitation of knee motion. In the second, during a revision procedure because of distal femur angulation. Premature consolidation was noted in one patient and was treated by osteotomy. In one case axial deviation during the consolidation phase required osteotomy. In another case a fracture of the femur was treated by a plaster cast. In one case 1.5 years after the lengthening procedure subluxation of the hip was noted. Permanent knee flexion limitation to less than 90 degrees was noted in 6 patients. Femoral lengthening with the use of the Italian modification of the Ilizarov device give a high incidence of knee range of motion limitation, which can be decreased by preserving more than 30 degrees knee flexion during the distraction phase.
本文介绍了采用改良的意大利伊利扎洛夫技术进行股骨延长的结果。患者的平均年龄为14岁（7至29岁）。肢体短缩最常见的病因是股骨发育不全（7例）以及髋和/或膝关节化脓性关节炎后遗症（6例）。手术治疗的指征为肢体短缩3至12厘米（平均6.5厘米），6例患者伴有10度至40度的轴向畸形。平均随访时间为15个月（6至35个月）。伊利扎洛夫器械基于两个远端环，通过“K”线固定，近端通过与意大利股骨弓相连的环固定，由一枚斯氏针稳定。所有接受治疗的患者均实现了计划的延长（3.5厘米至12厘米）。愈合指数为0.8至2.1月/厘米（平均1.4）。根据帕利分类法对问题、障碍和并发症进行了分析。在所有16例未进行初次膝关节稳定术的患者中，牵张期膝关节屈曲受限5度至90度（平均40度），在巩固期未显著改善。随访6个月后膝关节屈曲平均改善至90度。4例患者出现骨再生缺陷（囊肿、狭窄）。2例患者进行了二次膝关节稳定术。第一例是因为膝关节疼痛和膝关节活动严重受限。第二例是在翻修手术中因股骨远端成角。1例患者出现过早骨愈合，通过截骨术治疗。1例患者在巩固期出现轴向畸形，需要进行截骨术。另1例股骨骨折患者采用石膏固定治疗。1例患者在延长手术后1.5年出现髋关节半脱位。使用改良的意大利伊利扎洛夫装置进行股骨延长时，膝关节活动范围受限的发生率较高，在牵张期保持膝关节屈曲超过30度可降低该发生率。
