Kocaoglu Mehmet, Eralp Levent, Kilicoglu Onder, Burc Halil, Cakmak Mehmet
Department of Orthopaedics and Traumatology, Istanbul Medical School, Istanbul University, Capa, 34390 Topkapi, Istanbul, Turkey.
J Bone Joint Surg Am. 2004 Nov;86(11):2406-11. doi: 10.2106/00004623-200411000-00007.
In limb-lengthening, the quest for increased patient comfort and a reduced period of external fixation has led to techniques such as lengthening over an intramedullary nail. The goals of this study were to investigate the rate and types of complications encountered during lengthening over an intramedullary nail and to identify solutions to these complications.
Forty-two segments (thirty-five femora and seven tibiae) in thirty-five patients were lengthened. The mean age of the patients was 26.6 years, the mean amount lengthened was 6.3 cm (range, 2.5 to 11.5 cm), the mean external fixation index was 18.7 days/cm, and the mean lengthening index was 31.2 days/cm. The patients were followed for a mean period of forty-four months postoperatively.
Eighteen complications occurred in sixteen (38%) of the forty-two segments for a rate of 0.43 complication per segment. Complications were classified, according to the system of Paley et al., as two problems, thirteen obstacles, and three sequelae. Sixteen of them required additional surgical interventions. A preoperative score of >6.5 on the system of Paley et al., a lengthening of >6 cm, and a lengthening percentage of >21.5% of the original bone length were indicators of a higher probability of the occurrence of complications.
Lengthening over an intramedullary nail provides increased patient comfort and reduces the external fixation period. If the problems encountered are treated aggressively, the result of the treatment can be quite satisfactory.
在肢体延长术中，为了提高患者舒适度并缩短外固定时间，出现了诸如髓内钉延长术等技术。本研究的目的是调查髓内钉延长术中出现的并发症的发生率和类型，并确定这些并发症的解决方案。
对35例患者的42个节段（35个股骨和7个胫骨）进行了延长。患者的平均年龄为26.6岁，平均延长长度为6.3厘米（范围为2.5至11.5厘米），平均外固定指数为18.7天/厘米，平均延长指数为31.2天/厘米。术后对患者进行了平均44个月的随访。
42个节段中的16个（38%）出现了18例并发症，每个节段的并发症发生率为0.43。根据Paley等人的分类系统，并发症分为两类问题、13个障碍和3个后遗症。其中16例需要额外的手术干预。Paley等人的系统术前评分>6.5、延长长度>6厘米以及延长长度占原始骨长度的比例>21.5%是并发症发生概率较高的指标。
髓内钉延长术可提高患者舒适度并缩短外固定时间。如果积极处理遇到的问题，治疗结果会相当令人满意。
