Cho Tae-Joon, Lee Kang, Oh Chang-Wug, Park Moon Seok, Yoo Won Joon, Choi In Ho
Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, Republic of Korea. E-mail address for T.-J. Cho:
Department of Orthopaedic Surgery, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon, Gangwon-Do 200-722, Republic of Korea.
J Bone Joint Surg Am. 2015 May 6;97(9):733-7. doi: 10.2106/JBJS.N.01185.
Intramedullary rodding has been the mainstay of long-bone stabilization in osteogenesis imperfecta. However, in some cases, intramedullary rodding cannot provide adequate fixation because of a lack of rotational control and thin diameter of long bones. We have applied adjunctive unicortical locking plate fixation in selected cases of osteogenesis imperfecta to address these biomechanical issues.
Thirty-seven bone segments of twenty-four patients with osteogenesis imperfecta (ten type III, nine type IV, three type I, and two type V), in which unicortical locking plate fixation was applied adjunctive to intramedullary rodding and was later removed after union had been achieved, were the study subjects. The mean patient age at the time of surgery was 15.5 years (range, 6.2 to 39.8 years). Medical records and follow-up radiographs were reviewed to evaluate healing, complications, and the fates of screw holes after plate removal.
All fractures or osteotomies healed completely. Locking plates were removed postoperatively at a mean time (and standard deviation) of 1.8 ± 0.9 years (range, 0.3 to 3.8 years). In seven of the thirty-seven cases, fractures through the screw hole occurred; all of these were treated conservatively. In eighteen of nineteen cases that were followed for more than a year after plate removal without screw hole-related complication, screw holes healed and were no longer visualized by radiography.
Unicortical locking plate fixation effectively supplements intramedullary rod fixation in selected cases of osteogenesis imperfecta.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
髓内棒固定一直是成骨不全症长骨稳定的主要方法。然而，在某些情况下，由于缺乏旋转控制以及长骨直径较细，髓内棒固定无法提供足够的固定。我们在部分成骨不全症病例中应用了辅助性单侧皮质锁定钢板固定，以解决这些生物力学问题。
选取24例成骨不全症患者（10例III型、9例IV型、3例I型和2例V型）的37个骨段作为研究对象，这些病例在髓内棒固定的基础上应用了单侧皮质锁定钢板固定，待骨折愈合后取出钢板。手术时患者的平均年龄为15.5岁（范围6.2至39.8岁）。回顾病历和随访X线片，以评估愈合情况、并发症以及钢板取出后螺钉孔的转归。
所有骨折或截骨均完全愈合。锁定钢板术后平均在1.8±0.9年（范围0.3至3.8年）取出。37例中有7例发生螺钉孔处骨折，均采用保守治疗。在钢板取出后随访超过1年且无螺钉孔相关并发症的19例中的18例，螺钉孔愈合，X线片上不再显影。
在部分成骨不全症病例中，单侧皮质锁定钢板固定可有效补充髓内棒固定。
治疗性IV级。有关证据水平的完整描述，请参阅作者须知。
