Hankemeier Stefan, Pape Hans-Christoph, Gosling Thomas, Hufner Tobias, Richter Martinus, Krettek Christian
Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Arch Orthop Trauma Surg. 2004 Mar;124(2):129-33. doi: 10.1007/s00402-003-0625-6. Epub 2004 Jan 27.
Limb lengthening by external fixators is associated with many problems such as pain at the pin tracts, muscle transfixation, pin tract infections, reduced joint motion, and prolonged fixation time. The intramedullary skeletal kinetic distractor (ISKD) is a new internal, mechanically activated implant, which distracts by mild rotations of 3 degrees.
In a prospective clinical study, four patients with an mean age of 29 years (18-36 years) underwent intramedullary lengthening via ISKD. The average lengthening of three femora and one tibia was 31 mm (26-40 mm).
All patients performed the rotations for the distraction themselves without any significant problems. One patient took mild analgesics during the first days of distraction, whereas three patients did not require any analgesics. The average patient discharge occurred 10 days (8-11 days) postoperatively with no complications during the hospital stay. The planned length of distraction was achieved in all patients with normal alignment and normal joint orientation. Full weight bearing was performed on average after 10 weeks (7-14 weeks). Consolidation was noted 80 days (51-111 days) postoperatively with an average consolidation index of 2.9 days/mm. No complications were observed during the follow-up period of 14 months. The Enneking score was 26.8 points, and according to the classification of Paley all patients had an excellent result.
From these preliminary results we conclude that the comfort of limb lengthening with the ISKD is increased by the elimination of fixator-associated complications and by the simple distraction mechanism, which is well tolerated by the patients. Further advantages of the ISKD are early full weight bearing and excellent limb function.
使用外固定器进行肢体延长会引发诸多问题，如针道疼痛、肌肉贯穿、针道感染、关节活动度降低以及固定时间延长。髓内骨骼动力撑开器（ISKD）是一种新型的内部机械激活植入物，通过3度的轻微旋转进行撑开。
在一项前瞻性临床研究中，4名平均年龄为29岁（18 - 36岁）的患者通过ISKD进行了髓内延长。三根股骨和一根胫骨的平均延长长度为31毫米（26 - 40毫米）。
所有患者均自行进行撑开所需的旋转操作，未出现任何重大问题。1名患者在撑开的头几天服用了轻度镇痛药，而3名患者未需要任何镇痛药。患者平均在术后10天（8 - 11天）出院，住院期间无并发症。所有患者均实现了计划的撑开长度，对线和关节方向正常。平均在10周（7 - 14周）后开始完全负重。术后80天（51 - 111天）观察到骨愈合，平均骨愈合指数为2.9天/毫米。在14个月的随访期内未观察到并发症。Enneking评分为26.8分，根据Paley分类，所有患者结果均为优秀。
从这些初步结果我们得出结论，ISKD通过消除与固定器相关的并发症以及采用简单的撑开机制提高了肢体延长的舒适度，患者对该机制耐受性良好。ISKD的其他优点包括早期完全负重和出色的肢体功能。
