Sangkaew Chanchit
Department of Orthopaedic Surgery, Police General Hospital, Bangkok, Thailand.
Arch Orthop Trauma Surg. 2008 Sep;128(9):889-99. doi: 10.1007/s00402-007-0437-1. Epub 2007 Sep 15.
The author has developed a new simple technique of distraction osteogenesis using conventional monolateral external fixator for femoral lengthening. The primary purpose of the present study was to evaluate the results of treatment with this new technique of femoral lengthening and also to evaluate the effect of preoperative and intraoperative variables on the outcome of distraction osteogenesis in general.
Fifty-one femora in 50 patients were lengthened. Limb-length discrepancy was the primary indication in all patients. The mean age of the patients at the time of the surgery was 21.9 years (range 5-48 years). The average follow-up period was 24.6 months after removal of the fixator (range 6-120 months). All lengthenings were performed using conventional AO/ASIF external fixator. Twenty-two femora had associated axial or rotational deformities. Gradual distraction was performed to increase length and to correct angular deformity in coronal plane. Acute closed wedge angular correction in sagittal plane or derotation was performed in 12 femora in this study.
The length of the 51 femora was increased by an average 4.4 cm (range 1-13 cm), or 12% (range 2.5-40.9%). The average healing index was 50.5 days/cm (range 22.5-110.6 days/cm). Average gradual angular correction in coronal plane in 14 femora was 20.4 degrees (range 10-45 degrees ). Average acute correction in sagittal plane in five femora was 17 degrees (range 10-20 degrees ). Average acute derotation in six femora was 24.2 degrees (range 10-60 degrees ). There were a total of 61 complications, including 26 problems, 18 obstacles, and 17 sequelae. The overall rate of complications was 1.2 per femur. Fifteen femora had delayed consolidation (healing index >54 days/cm). Three of 51 lengthening procedures did not lead to consolidation (nonunion). A significant negative parabolic relationship was noted between the healing index and the amount of length gained (R = -0.47 and P = 0.004). There was a significantly positive exponential relationship between age and healing index (R = 0.51 and P < 0.001). Acute deformity correction, level of osteotomy (submetaphysis versus diaphysis) had no significant effect on healing index. The greater amount of length gained was associated with complications.
The newly presented technique of distraction osteogenesis is a useful and cost-effective method for femoral lengthening. Increased lengthenings produced a better healing index but might associate with complications. Younger age was associated with better bone healing but age had no effect on complication rate. Level of osteotomy, acute deformity correction had no effect on healing index and rate of complications.
作者研发了一种使用传统单侧外固定器进行股骨延长的新型简易牵张成骨技术。本研究的主要目的是评估这种新型股骨延长技术的治疗效果，并总体评估术前和术中变量对牵张成骨结果的影响。
对50例患者的51根股骨进行了延长。肢体长度差异是所有患者的主要指征。手术时患者的平均年龄为21.9岁（范围5 - 48岁）。去除固定器后的平均随访期为24.6个月（范围6 - 120个月）。所有延长均使用传统的AO/ASIF外固定器进行。22根股骨伴有轴向或旋转畸形。进行逐步牵张以增加长度并纠正冠状面的角畸形。本研究中，12根股骨在矢状面进行了急性闭合楔形角矫正或旋转矫正。
51根股骨的长度平均增加了4.4厘米（范围1 - 13厘米），即12%（范围2.5 - 40.9%）。平均愈合指数为50.5天/厘米（范围22.5 - 110.6天/厘米）。14根股骨在冠状面的平均逐步角矫正为20.4度（范围10 - 45度）。5根股骨在矢状面的平均急性矫正为17度（范围10 - 20度）。6根股骨的平均急性旋转矫正为24.2度（范围10 - 60度）。共有61例并发症，包括26个问题、18个障碍和17个后遗症。并发症的总体发生率为每根股骨1.2例。15根股骨出现延迟愈合（愈合指数>54天/厘米）。51例延长手术中有3例未实现愈合（骨不连）。愈合指数与延长长度之间存在显著的负抛物线关系（R = -0.47，P = 0.004）。年龄与愈合指数之间存在显著的正指数关系（R = 0.51，P < 0.001）。急性畸形矫正、截骨水平（干骺端与骨干）对愈合指数无显著影响。延长长度越大，并发症越多。
新提出的牵张成骨技术是一种用于股骨延长的实用且经济有效的方法。延长量增加可产生更好的愈合指数，但可能伴有并发症。年龄较小与更好的骨愈合相关，但年龄对并发症发生率无影响。截骨水平、急性畸形矫正对愈合指数和并发症发生率无影响。
