成骨不全患儿股骨延长杆的近端移位

Proximal migration of femoral telescopic rod in children with osteogenesis imperfecta.

作者信息

Lee Kang, Park Moon Seok, Yoo Won Joon, Chung Chin Youb, Choi In Ho, Cho Tae-Joon

机构信息

*Division of Pediatric Orthopaedics, Kangwon National University Children's Hospital, Chuncheon †Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam ‡Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea.

出版信息

J Pediatr Orthop. 2015 Mar;35(2):178-84. doi: 10.1097/BPO.0000000000000228.

DOI:10.1097/BPO.0000000000000228

PMID:24919136

Abstract

BACKGROUND

Intramedullary telescopic rod fixation has been used for stabilization of the long bones in growing children who have osteogenesis imperfecta. Proximal migration of the rod is the most common complication of telescopic rodding in the femur. The purposes of this study were to evaluate incidence and temporal pattern of proximal migration of the femoral rod, and to investigate factors related to it.

METHODS

A total of 50 patients with osteogenesis imperfecta, who had femur stabilized by telescopic rod with T-piece, were the subjects of this study. In patients having both the femora stabilized, only 1 femur was randomly selected for analysis. Hence, in 50 femora, migration-free survivorship was analyzed using the Kaplan-Meier method, and association with possible risk factors was analyzed by Cox regression analysis using the proportional hazards model. Factors investigated in the analysis include age at the time of surgery, sex, purpose of the index surgery, residual or developing angular deformity of the femur, rod position at the distal physis, persistent cortical gap at fracture/osteotomy site, Sillence classification, and type of telescopic rod.

RESULTS

Proximal migration was observed in 7 of 50 femora. Cumulative survival without proximal migration was 0.94 (95% CI, 0.87-1.01) in 1 year, and 0.85 (95% CI, 0.75-0.95) in 6 years. Factors significantly associated with proximal rod migration in Kaplan-Meier survivorship analysis and univariate Cox regression analysis were angular deformity, eccentric rod position at the distal physis, and persistent cortical gap. When these factors were analyzed by multivariate analysis, eccentric rod position at the distal physis was the only significant factor with a hazard ratio of 11.74.

CONCLUSIONS

The risk of proximal rod migration can be reduced by complete correction of angular deformity and optimal placement of the rod at the distal physis. Our data also suggest that developing angular deformity or persistent osteotomy/fracture gap requires special attention at the possibility of proximal rod migration during follow-up.

LEVEL OF EVIDENCE

Level III, prognostic study.

摘要

背景

髓内伸缩杆固定术已用于患有成骨不全症的生长发育期儿童长骨的稳定。杆的近端移位是股骨伸缩杆固定术最常见的并发症。本研究的目的是评估股骨杆近端移位的发生率和时间模式，并调查与之相关的因素。

方法

本研究共纳入50例采用带T形件的伸缩杆固定股骨的成骨不全症患者。在双侧股骨均行固定的患者中，仅随机选择1侧股骨进行分析。因此，对50侧股骨采用Kaplan-Meier法分析无移位生存率，并使用比例风险模型通过Cox回归分析其与可能的危险因素的相关性。分析中研究的因素包括手术时年龄、性别、首次手术目的、股骨残留或进展性角畸形、杆在远端骨骺的位置、骨折/截骨部位持续存在的皮质间隙、Sillence分型以及伸缩杆类型。

结果

50侧股骨中有7侧观察到近端移位。1年时无近端移位的累积生存率为0.94（95%CI，0.87-1.01），6年时为0.85（95%CI，0.75-0.95）。在Kaplan-Meier生存率分析和单因素Cox回归分析中，与近端杆移位显著相关的因素是角畸形、杆在远端骨骺的偏心位置以及持续存在的皮质间隙。当对这些因素进行多因素分析时，杆在远端骨骺的偏心位置是唯一具有显著意义的因素，风险比为11.74。