Department of Orthopaedic Surgery, Fuzhou General Hospital, Fuzhou 350025, Fujian, China.
Arch Orthop Trauma Surg. 2011 Oct;131(10):1333-40. doi: 10.1007/s00402-011-1302-9. Epub 2011 Apr 13.
Callus progression is a great concern during limb lengthening. In this study, we investigated the difference in callus progression between tibial lengthenings with and without intramedullary nail.
Seventy tibiae in 38 patients with an average age of 24 years were lengthened with Ilizarov external fixator and nail; 56 tibiae in 40 patients with an average age of 28.6 years were lengthened with the same Ilizarov external fixator but without nail. The callus progression was compared with reference to pixel value ratio (PVR) and Ru Li's classification. Statistical analysis was performed to compare the variation trend of PVR and incidence of various callus pathways (particular patterns of callus progression as outlined in Ru Li's classification) and shapes of each aspect of callus between the two groups.
The trend of PVR was not statistically different in posterior, lateral and medial aspects of the callus between the two groups, but averagely lower in the anterior aspect in the group without nail than that with nail. The group without nail presented less incidence of homogeneous pathway, greater incidence of heterogeneous pathway; also greater incidence of fusiform callus, less incidence of cylindrical callus.
It was concluded that with nail, the callus underwent a more favorable progression and even longer lengthening could be allowed.
在肢体延长过程中，骨痂的进展是一个非常关注的问题。在这项研究中，我们研究了髓内钉固定和非髓内钉固定对骨痂进展的影响。
70 例患者的 70 胫骨（平均年龄 24 岁）采用伊利扎洛夫外固定架和髓内钉延长，40 例患者的 56 胫骨（平均年龄 28.6 岁）采用相同的伊利扎洛夫外固定架但不使用髓内钉延长。通过像素值比（PVR）和鲁力分类来比较骨痂进展的差异。通过比较两组 PVR 变化趋势、各种骨痂途径（鲁力分类中概述的特定骨痂进展模式）的发生率以及骨痂各方面的形状，对两组数据进行统计学分析。
两组在骨痂的后、外和内侧面 PVR 趋势没有统计学差异，但在无钉组的前侧面平均低于有钉组。无钉组同质性途径发生率较低，异质性途径发生率较高；纺锤形骨痂发生率较高，圆柱形骨痂发生率较低。
有髓内钉固定时，骨痂的进展更为有利，甚至可以允许更长的延长。
