Song Hae-Ryong, Soma Raju V V J, Kumar Satish, Lee Seok-Hyun, Suh Seung-Woo, Kim Jung-Ryul, Hong Jun-Seok
Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea.
Acta Orthop. 2006 Apr;77(2):307-14. doi: 10.1080/17453670610046073.
There are many modalities of treatment for complex lower extremity deformity in hypophosphatemic rickets. We evaluated the outcomes of deformity correction using an external fixation and/or intramedullary nailing in hypophosphatemic rickets.
55 segmental deformities (20 femora, 35 tibiae) from 20 patients were examined retrospectively. There were 9 children and 11 adults. Distraction osteogenesis was used in 28 segments and acute deformity correction in 27. External fixation was applied in 24 segments, intramedullary nailing in 6, and external fixation and intramedullary nailing in 25.
There were 18 major and 13 minor complications in 26 of 28 segments with distraction osteogenesis, and 13 major and 10 minor complications in 19 of 27 segments with acute correction. Recurrent deformity or refracture occurred in 10 of 21 segments with distraction osteogenesis by external fixation only, 4 of 6 with acute correction by intramedullary nailing, and 1 of 25 with distraction osteogenesis or acute correction by external fixation and intramedullary nailing. Nail-related complications occurred in 3 of 6 with intramedullary nailing and 2 of 25 with external fixation and intramedullary nailing.
External fixation and intramedullary nailing can be recommended to prevent complications during or after deformity correction in hypophosphatemic rickets.
低磷性佝偻病复杂下肢畸形的治疗方法有多种。我们评估了低磷性佝偻病采用外固定和/或髓内钉进行畸形矫正的效果。
回顾性研究了20例患者的55处节段性畸形（20处股骨，35处胫骨）。其中儿童9例，成人11例。28处节段采用牵张成骨，27处采用急性畸形矫正。24处节段应用外固定，6处应用髓内钉，25处应用外固定加髓内钉。
28处采用牵张成骨的节段中，26处出现18例严重并发症和13例轻微并发症；27处采用急性矫正的节段中，19处出现13例严重并发症和10例轻微并发症。仅采用外固定进行牵张成骨的21处节段中，10处出现复发畸形或再骨折；采用髓内钉进行急性矫正的6处节段中，4处出现复发畸形或再骨折；采用外固定加髓内钉进行牵张成骨或急性矫正的25处节段中，1处出现复发畸形或再骨折。采用髓内钉的6处节段中有3处出现与髓内钉相关的并发症，采用外固定加髓内钉的25处节段中有2处出现与髓内钉相关的并发症。
对于低磷性佝偻病畸形矫正期间或之后预防并发症，可推荐采用外固定和髓内钉。
