Guichet Jean-Marc, Deromedis Barbara, Donnan Leo T, Peretti Giovanni, Lascombes Pierre, Bado Flavio
Children's Hospital, Nancy, France.
J Bone Joint Surg Am. 2003 May;85(5):838-48. doi: 10.2106/00004623-200305000-00011.
Gradual limb lengthening with currently used external fixation techniques can result in less than optimal outcomes, with complications including infection, stiffness of adjacent joints, and secondary axial deviation of the extremity. We describe a totally implantable lengthening device designed to provide results similar to those achieved with external fixation devices, with fewer complications and improved outcomes.
Between 1993 and 1997, thirty-one patients (forty-one femora) underwent limb lengthening with a new internal fixation technique (Albizzia) to treat a congenitally short extremity (thirteen patients), post-traumatic limb-length inequality (eleven patients), or developmental problems (seven patients). Twenty-one patients (twenty-one femora) underwent unilateral surgery to equalize the limb lengths, and ten (twenty femora) underwent bilateral surgery to correct short stature. The mean age was twenty years and one month (range, twelve to thirty-nine years). After intramedullary corticotomy of the diaphysis of the femur, an intramedullary nail was inserted in an antegrade fashion. Fifteen alternating internal and external rotation maneuvers of the lower limb elongated the nail by 1 mm. The outcomes were assessed clinically and radiographically at a mean of fifty months postoperatively.
The gain in femoral length averaged 3.4 cm (range, 2 to 5.5 cm) after the unilateral lengthening procedures and 6.3 cm (range, 4.6 to 8.4 cm) after the bilateral procedures. Patients underwent an average of three operations on each limb; these procedures included, in addition to the nail insertion and nail removal, ratcheting under general anesthesia in thirteen limbs and eleven procedures to treat complications in nine patients. At the time of follow-up, no patient had axial deviation of the limb secondary to lengthening.
Femoral lengthening with use of the minimally invasive Albizzia technique provides a reasonable alternative to external fixation that is well tolerated by patients and results in excellent function with little or no distortion of body image.
采用目前的外固定技术进行肢体逐渐延长可能导致不太理想的结果，并发症包括感染、相邻关节僵硬以及肢体继发轴向偏差。我们描述了一种完全可植入的延长装置，其设计目的是提供与外固定装置相似的效果，同时减少并发症并改善治疗结果。
1993年至1997年期间，31例患者（41个股骨）采用一种新的内固定技术（合欢树技术）进行肢体延长，以治疗先天性肢体短小（13例患者）、创伤后肢体长度不等（11例患者）或发育问题（7例患者）。21例患者（21个股骨）接受单侧手术以均衡肢体长度，10例（20个股骨）接受双侧手术以矫正身材矮小。平均年龄为20岁1个月（范围为12至39岁）。在股骨骨干进行髓内截骨术后，以顺行方式插入髓内钉。下肢进行15次内外旋转交替操作可使钉子延长1毫米。术后平均50个月时通过临床和影像学评估结果。
单侧延长手术后股骨长度平均增加3.4厘米（范围为2至5.5厘米），双侧手术后平均增加6.3厘米（范围为4.6至8.4厘米）。患者每侧肢体平均接受三次手术；这些手术除了包括插入和取出钉子外，还包括在13个肢体中进行全身麻醉下的棘轮操作以及对9例患者的11次治疗并发症的手术。随访时，没有患者因延长而出现肢体轴向偏差。
使用微创合欢树技术进行股骨延长为外固定提供了一种合理的替代方法，患者耐受性良好，功能良好，且对身体形象几乎没有或没有影响。
