Koczewski Paweł, Shadi Milud
Department of Pediatric Orthopedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland.
Pol Orthop Traumatol. 2012 Sep 18;77:65-71.
The aim of the study is to analyze the results of treating the lower limb inequality with subtrochanteric femoral shortening osteotomy fixed with interlocking intramedullary nail. The analyzed material includes 14 patients aged 16 to 36 (mean 25), in whom femoral shortening osteotomy fixed with interlocking nail was performed. In all patients the indication for this therapeutic method was lower limb inequality caused by femur shortening and accompanied by contraindication for femoral lengthening procedure. Limb length inequality ranged from 1.5 to 6.0 cm (mean 3.8). The follow-up period was between 2 and 6 years (mean 3.8).
MATERIAL/METHODS: All patients underwent open subtrochanteric femoral osteotomy with interlocking intramedullary nail fixation. The amount of bone resected from the femoral subtrochanteric area ranged from 1.5 to 4.5 cm (mean 3.3). Dynamization of the nail (removal of one or two peripheral interlocking screws) was performed in 11 patients.
In all patients the expected limb shortening was achieved. Osteotomy site union was observed in 8 out of 14 patients 3.5 to 6 months (mean 4.8) after the surgery. In 3 patients delayed union was observed after 10-12 months (mean 11). In other 3 patients the lack of union did not cause any major problems, but it required additional surgical intervention (Judet-Forbes procedure, PRP administration). Following the procedure the union was observed after 30, 31 and 60 months respectively.
Subtrochanteric femoral shortening osteotomy fixed with interlocking intramedullary nail is a good alternative method in lower limb inequality treatment in the adult patients in whom the Ilizarov method is contraindicated. Few complications such as delayed union are well tolerated due to intramedullary fixation, and only some of them may require secondary surgical intervention.
本研究旨在分析采用带锁髓内钉固定的股骨转子下缩短截骨术治疗下肢不等长的结果。分析的材料包括14例年龄在16至36岁（平均25岁）的患者，这些患者均接受了带锁髓内钉固定的股骨缩短截骨术。在所有患者中，采用这种治疗方法的指征是由股骨缩短引起的下肢不等长，并伴有股骨延长术的禁忌证。肢体长度不等范围为1.5至6.0厘米（平均3.8厘米）。随访期为2至6年（平均3.8年）。
材料/方法：所有患者均接受了开放性股骨转子下截骨术并采用带锁髓内钉固定。从股骨转子下区域切除的骨量范围为1.5至4.5厘米（平均3.3厘米）。11例患者进行了髓内钉动力化（去除一或两个周边锁钉）。
所有患者均实现了预期的肢体缩短。14例患者中有8例在术后3.5至6个月（平均4.8个月）观察到截骨部位愈合。3例患者在10至12个月（平均11个月）后观察到延迟愈合。其他3例患者未愈合未引起任何重大问题，但需要额外的手术干预（Judet-Forbes手术、注射富血小板血浆）。术后分别在30、31和60个月观察到愈合。
对于禁忌采用伊里扎洛夫方法的成年患者，带锁髓内钉固定的股骨转子下缩短截骨术是治疗下肢不等长的一种良好替代方法。由于髓内固定，很少有诸如延迟愈合等并发症能被很好地耐受，只有其中一些可能需要二次手术干预。
