Franzone Jeanne M, Kruse Richard W
Department of Orthopaedics of the Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
J Pediatr Orthop B. 2018 Jul;27(4):344-349. doi: 10.1097/BPB.0000000000000405.
Although intramedullary fixation is the standard form of surgical fixation of the long bones of children with osteogenesis imperfecta (OI), it remains fraught with complications. Implant breakage, implant cut out, long bone fracture, nonunion, and rod bending have all been described as complications of intramedullary long bone fixation in children with OI. Supplemental fixation techniques represent an attempt to decrease these risks of surgical implant failure of intramedullary devices. A supplemental plate and screw construct at a fracture or an osteotomy site in addition to an intramedullary device in the long bone segment is one such form of supplemental fixation. The aim of this study is to describe the surgical technique and early results of plate and screw fixation used to supplement intramedullary fixation in a subset of our OI patient population. This is a retrospective review and report on 14 long bone segments of 11 children with OI who have undergone intramedullary fixation as well as supplemental fixation at osteotomy or fracture sites with a plate and screw construct. The long bone segments treated with intramedullary fixation and a supplemental plate and screw construct included 11 femurs, two tibias, and one humerus. Intramedullary devices included a combination of telescoping and nontelescoping implants. The mean follow-up duration was 10 months. All 14 long bone segments have gone on to radiographic union. The average time to union was 8.8 weeks (range: 6.5-17 weeks). In 11 of the long bone segments, the supplemental plate fixation was applied to the site of a fracture or osteotomy. In one case, supplemental plate fixation was applied to the site of a nonunion (distal humerus nonunion). We describe various options of this surgical technique and early results. Although further follow-up and investigation will provide further insight into long-term outcomes, supplemental plate and screw fixation is a valuable and versatile option for this challenging patient population.
尽管髓内固定是成骨不全（OI）患儿长骨手术固定的标准方式，但它仍然充满并发症。植入物断裂、植入物穿出、长骨骨折、骨不连和髓内棒弯曲都被描述为OI患儿髓内长骨固定的并发症。辅助固定技术旨在降低髓内装置手术植入失败的这些风险。在长骨段的髓内装置基础上，在骨折或截骨部位附加钢板和螺钉结构就是一种辅助固定形式。本研究的目的是描述用于补充我们部分OI患者群体髓内固定的钢板和螺钉固定的手术技术及早期结果。这是一项对11例接受髓内固定以及在截骨或骨折部位采用钢板和螺钉结构进行辅助固定的OI患儿的14个长骨段的回顾性研究及报告。接受髓内固定和辅助钢板及螺钉结构治疗的长骨段包括11根股骨、2根胫骨和1根肱骨。髓内装置包括可伸缩和不可伸缩植入物的组合。平均随访时间为10个月。所有14个长骨段均实现了影像学骨愈合。平均愈合时间为8.8周（范围：6.5 - 17周）。在11个长骨段中，辅助钢板固定应用于骨折或截骨部位。在1例中，辅助钢板固定应用于骨不连部位（肱骨远端骨不连）。我们描述了这种手术技术的各种选择及早期结果。尽管进一步的随访和研究将提供对长期结果的进一步见解，但辅助钢板和螺钉固定对于这个具有挑战性的患者群体来说是一种有价值且通用的选择。
