Koczewski Paweł, Shadi Milud
Department of Paediatric Orthopaedics and Traumatology Karol Marcinkowski medical University in Poznań, Poland.
Ortop Traumatol Rehabil. 2013 Nov-Dec;15(6):591-9. doi: 10.5604/15093492.1091515.
The dynamics and effectiveness of new bone formation in the Ilizarov method varies according to different factors. Some of them may result in substantial prolongation of treatment time. The lengthening index (LI), defined as the number of months in a frame necessary to achieve 1 cm lengthening, is the main indicator of bone healing potential. The purpose of the study was to assess the effectiveness of distraction osteogenesis by analysing the lengthening index (LI) in relation to: age, limb length discrepancy, aetiology, bone segment involved, axial correction and lengthening achieved. We studied 251 patients between the ages of 3 to 50 years (mean 15.3) treated with the Ilizarov method because of lower limb inequality. A total of 319 lengthening procedures were analyzed (tibia--155, femur--164).
Total treatment time (time in a frame) and magnitude of lengthening were recorded in all patients to calculate LI (months per 1cm of lengthening). Patients were divided into several groups according to these factors.
Mean LI in the entire sample was 1.6 months/cm (from 0.7 to 5.9). The lowest LI (1.4) was recorded in the youngest patients (from 3 to 9 years) and increased with age, amounting to 1.6 in the 10-17 years' age group, 1.7 in the 18-21 years' age group and 2.4 in the 22-50 years' age group. The mean LI for femoral lengthening was lower (1.5) than for the tibias (1.8). In a group of 63 cases of lengthening up to 4 cm, LI was 2.3; in another group (from 4 to 7 cm - 189 procedures) LI was lower (1.6), and in the last group (more than 7 cm) it was 1.2. There was no significant difference in mean LI between the groups with and without axial correction. However, differences between aetiology groups were statistically significant, with a mean LI of 1.2 in achondroplasia patients, 1.4 in post-septic patients and patients with and Ollier disease, 1.6 in patients with congenital deformities, 1.8 in post-traumatic patients and 2.0 in neurogenic and clubfoot patients.
According to the lengthening index analysis, the effectiveness of distraction osteogenesis is related to age, aetiology, bone segment involved and the magnitude of lengthening, while it is not related to axial correction.
伊里扎洛夫方法中新骨形成的动力学和有效性因不同因素而异。其中一些因素可能会导致治疗时间大幅延长。延长指数（LI）定义为实现1厘米延长所需的框架内月数，是骨愈合潜力的主要指标。本研究的目的是通过分析延长指数（LI）与年龄、肢体长度差异、病因、受累骨段、轴向矫正和实现的延长之间的关系，评估牵张成骨的有效性。我们研究了251例年龄在3至50岁（平均15.3岁）之间因下肢不等长而接受伊里扎洛夫方法治疗的患者。共分析了319例延长手术（胫骨——155例，股骨——164例）。
记录所有患者的总治疗时间（框架内时间）和延长幅度，以计算LI（每延长1厘米的月数）。根据这些因素将患者分为几组。
整个样本的平均LI为1.6个月/厘米（范围为0.7至5.9）。最年轻患者（3至9岁）的LI最低（1.4），并随年龄增加，10至17岁年龄组为1.6，18至21岁年龄组为1.7，22至50岁年龄组为2.4。股骨延长的平均LI（1.5）低于胫骨（1.8）。在一组63例延长达4厘米的病例中，LI为2.3；在另一组（4至7厘米——189例手术）中LI较低（1.6），最后一组（超过7厘米）为1.2。有轴向矫正组和无轴向矫正组之间的平均LI无显著差异。然而，病因组之间的差异具有统计学意义，软骨发育不全患者的平均LI为1.2，脓毒症后患者和奥利尔病患者为1.4，先天性畸形患者为1.6，创伤后患者为1.8，神经源性和马蹄内翻足患者为2.0。
根据延长指数分析，牵张成骨的有效性与年龄、病因、受累骨段和延长幅度有关，而与轴向矫正无关。
