Szymczuk Vivian L, Hammouda Ahmed I, Gesheff Martin G, Standard Shawn C, Herzenberg John E
Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
Department of Orthopedics and Trauma, Al-Azhar University Hospitals, Cairo, Egypt.
J Pediatr Orthop. 2019 Oct;39(9):458-465. doi: 10.1097/BPO.0000000000001047.
Limb lengthening for congenital femoral deficiency (CFD) with or without fibular hemimelia can be performed with both external and internal devices. The purpose of this study is to compare clinical outcomes of femoral lengthening utilizing monolateral external fixation versus a magnetically motorized intramedullary nail in patients with CFD with or without fibular hemimelia.
This retrospective review included 62 patients with femoral lengthening, 32 patients had monolateral external fixation (group A), 30 patients had internal lengthening nail (group B). Mean age in years was 9.4±3.8 and 15.4±4.9 for groups A and B, respectively. Mean follow-up in years was 4.47±2.7 and 1.86±0.7 years for groups A and B, respectively.
Mean lengthening achieved was 5.6±1.7 and 4.8±1.4 cm for group A and group B, respectively (P=0.052). Mean distraction index was 0.7±0.2 mm/d for group A and 0.7±0.2 mm/d for the group B (P=0.99). Mean consolidation index for group A was 29.3±12.7 and 34.8±11.2 d/cm for group B (P=0.08). Mean arc of motion before surgery and at final follow-up were similar between groups (P=0.35). Group A had significantly less range of motion at the end of distraction (P=0.0007) and at consolidation (P<0.0001). Both groups had similar rates of obstacles and complications. A significant difference between groups was found in the total problems (P<0.001) specifically with pin site/superficial infection (P<0.0001).
The intramedullary nail had superior range of motion during the lengthening phase and at consolidation and an overall lower problem complication rate, while maintaining similar distraction and healing indices to monolateral external fixation. Internal lengthening nails represent a significant advance in technology for CFD lengthening.
Level IV-therapeutic.
对于伴有或不伴有腓骨半侧发育不全的先天性股骨缺如（CFD），可使用外固定装置和内固定装置进行肢体延长。本研究的目的是比较使用单侧外固定与电动髓内钉对伴有或不伴有腓骨半侧发育不全的CFD患者进行股骨延长的临床效果。
这项回顾性研究纳入了62例接受股骨延长的患者，32例采用单侧外固定（A组），30例采用髓内延长钉（B组）。A组和B组的平均年龄分别为9.4±3.8岁和15.4±4.9岁。A组和B组的平均随访时间分别为4.47±2.7年和1.86±0.7年。
A组和B组平均延长长度分别为5.6±1.7 cm和4.8±1.4 cm（P = 0.052）。A组和B组的平均牵伸指数均为0.7±0.2 mm/d（P = 0.99）。A组的平均愈合指数为29.3±12.7 d/cm，B组为34.8±11.2 d/cm（P = 0.08）。两组术前和最终随访时的平均活动弧度相似（P = 0.35）。A组在牵伸结束时（P = 0.0007）和愈合时（P < 0.0001）的活动范围明显较小。两组的障碍和并发症发生率相似。两组在总问题方面存在显著差异（P < 0.001），特别是在针道/浅表感染方面（P < 0.0001）。
髓内钉在延长阶段和愈合时具有更好的活动范围，总体问题并发症发生率较低，同时保持与单侧外固定相似的牵伸和愈合指数。髓内延长钉代表了CFD延长技术的重大进步。
四级治疗性。
