Steiger C N, Lenze U, Krieg A H
Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Basel, Switzerland.
Service d'Orthopédie pédiatrique, Hopitaux Universitaires Genève, Genève, Switzerland.
J Child Orthop. 2018 Oct 1;12(5):515-525. doi: 10.1302/1863-2548.12.170190.
Intramedullary lengthening nails are an accepted alternative to external fixators but are limited by anatomical preconditions. Therefore, to date the use of external fixators is sometimes inevitable. We report on a new technique for correction of combined limb length discrepancies and complex axis deformities using solely internal devices - a lengthening nail and a locking plate.
Between October 2008 and November 2011 five patients (two femora, three tibias) with a mean leg length discrepancy of 36 mm (25 to 50) and a complex angular deformity were treated with a fully implantable motorized lengthening nail (Fitbone) and a locking plate. All patients were evaluated with regards to the pre- and postoperative leg length as well as axis alignment, functional outcome, lengthening indices and complications.
A successful leg length equalization was achieved in all cases and physiological joint orientation angles in all but one case. The mean distraction index was 1.2 mm/day, the maturation index 24 days/cm and the consolidation index 35 days/cm. The functional outcome was very encouraging in all cases with bilateral free range of movement. In total, two complications were observed, one nonunion and one loss of leg length after an early locking bolt removal in a peripheral hospital.
The combination of a fully implantable motorized lengthening nail and a locking plate is a valuable alternative option for treating selected cases with limb length discrepancies in combination with a complex deformity of the lower leg. However, the reported technique puts high demands on the preoperative planning, operative technique as well as surgeon's skills.
IV (retrospective series).
髓内延长钉是外固定器的一种可接受替代方案，但受解剖学先决条件限制。因此，迄今为止有时不可避免地要使用外固定器。我们报告一种仅使用内部装置——延长钉和锁定钢板来矫正肢体长度联合差异和复杂轴线畸形的新技术。
2008年10月至2011年11月期间，对5例患者（2例股骨、3例胫骨）进行治疗，这些患者平均腿长差异为36 mm（25至50 mm）且存在复杂角畸形，采用完全可植入的电动延长钉（Fitbone）和锁定钢板进行治疗。对所有患者进行术前和术后腿长、轴线对线、功能结果、延长指数及并发症方面的评估。
所有病例均成功实现腿长均衡，除1例患者外其余患者关节方位角均恢复正常。平均牵张指数为1.2 mm/天，成熟指数为24天/cm，骨愈合指数为35天/cm。所有病例的功能结果都非常令人鼓舞，双侧活动范围均正常。总共观察到2例并发症，1例骨不连，1例在外地医院过早拆除锁定螺栓后出现腿长丢失。
完全可植入的电动延长钉与锁定钢板相结合是治疗选定病例中肢体长度差异合并小腿复杂畸形的一种有价值的替代选择。然而，所报道的技术对术前规划、手术技术以及外科医生的技能要求很高。
IV（回顾性系列研究）
