Burke N G, Cassar-Gheiti A J, Tan J, McHugh G, O'Neil B J, Noonan M, Moore D
Department of Orthopaedic Surgery, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
J Child Orthop. 2017 Jun 1;11(3):210-215. doi: 10.1302/1863-2548.11.160216.
Femoral lengthening using a circular or mono-lateral frame is a commonly used technique. Fracture at the site of the regenerate bone is a major concern especially following removal of the external fixator. This aim of this study was to assess the rate of fracture of the regenerate bone in this single surgeon series of paediatric patients and determine potential risk factors.
Retrospective review of all the femoral lengthening performed by the senior author was performed. The medical and physiotherapy notes were reviewed. The gender, age at time of surgery, disease aetiology, total days in the external fixator and length of the new regenerate bone were recorded. Patients who sustained a regenerate fracture were identified.
A total of 176 femoral lengthening procedures were performed on 108 patients. Eight regenerate fractures occurred in seven patients (4.5%). The mechanism of injury was a fall in five cases and during physiotherapy in three cases. The regenerate fracture occurred a median number of nine days following removal of frame. There was no significant difference between gender, age at time of surgery, total time in external fixator between those who sustained a regenerate fracture and those patients who did not. A significant difference was noted between the amount of lengthening between the 'regenerate fracture group' and the 'no fracture group' (50 mm 38 mm, respectively; p = 0.029). There was no association between disease aetiology and risk of regenerate fracture.
Femoral lengthening of more than 50 mm increases the risk of a fracture at the regenerate site regardless of the disease aetiology. We recommend avoidance of aggressive physiotherapy for the initial four weeks following external fixator removal.
使用环形或单侧外固定架进行股骨延长是一种常用技术。再生骨部位的骨折是一个主要问题，尤其是在拆除外固定架之后。本研究的目的是评估该单中心儿科患者系列中再生骨的骨折发生率，并确定潜在风险因素。
对资深作者所做的所有股骨延长手术进行回顾性分析。查阅医疗和物理治疗记录。记录患者的性别、手术时年龄、疾病病因、外固定架使用总天数以及新生再生骨的长度。确定发生再生骨骨折的患者。
对108例患者共进行了176次股骨延长手术。7例患者发生了8次再生骨骨折（4.5%）。损伤机制为5例跌倒和3例物理治疗期间。再生骨骨折发生在拆除外固定架后中位数9天。发生再生骨骨折的患者与未发生骨折的患者在性别、手术时年龄、外固定架使用总时长方面无显著差异。“再生骨骨折组”与“无骨折组”之间的延长量存在显著差异（分别为50毫米和38毫米；p = 0.029）。疾病病因与再生骨骨折风险之间无关联。
无论疾病病因如何，股骨延长超过50毫米会增加再生部位骨折的风险。我们建议在拆除外固定架后的最初四周避免积极的物理治疗。
