Leiva-Gea Antonio, Delgado-Rufino Francisco Borja, Queipo-de-Llano Alfonso, Mariscal-Lara Jorge, Lombardo-Torre Maximiano, Luna-González Felipe
Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen de la Victoria, Andalusian Public Health Service, Málaga, Andalucía, Spain.
Arch Orthop Trauma Surg. 2020 Nov;140(11):1665-1676. doi: 10.1007/s00402-020-03360-3. Epub 2020 Feb 11.
Surgical lengthening and angular correction of the limbs are an option for treating the orthopedic clinical manifestations in patients with achondroplasia. This study assesses a staged limb lengthening protocol, performing simultaneous bilateral lengthening of the femur and tibia (stage I [S1]), and humeral lengthening (stage II [S2]).
Twenty-one achondroplastic patients were included in this study, and 106 segments (34 femurs, 34 tibias and 38 humeri) were lengthened. Achondroplasia patients with a growth curve below the mean of the standard growth curves for achondroplasia were included in S1. The remaining patients were included directly in S2. Variables analyzed included anthropometric measurements, lengthening outcomes, difficulties, and functionality.
Of the all patients included in the protocol, 15 patients completed S1 and S2, 4 only completed S2, and 2 only completed S1. Height and limb-trunk ratio before S1 were 107.65 ± 7.14 cm and 1.89 ± 0.10 and after S1 were 126.50 ± 9.19 cm and 1.64 ± 0.09, respectively. Limbs were lengthened 14.43 ± 1.41 cm (femurs and tibias) for S1 and 9.95 ± 0.60 cm for S2 (humeri), with a stage healing index of 18.23 ± 3.54 in S1 and 28.92 ± 4.42 in S2. Correction of lower angular deviations, functional improvement, and a controlled complications rate were achieved in all patients.
The limb lengthening protocol proposed in this study is a suitable treatment for achondroplasia patients to achieve the agreed-upon objectives (limb-trunk ratio, improved functionality, and lower limb alignment). The reproducibility of the procedure and patient safety were upheld.
肢体的外科延长和角度矫正可作为治疗软骨发育不全患者骨科临床表现的一种选择。本研究评估了一种分期肢体延长方案，即同时进行双侧股骨和胫骨延长（I期[S1]）以及肱骨延长（II期[S2]）。
本研究纳入了21例软骨发育不全患者，共延长了106个节段（34个股骨、34个胫骨和38个肱骨）。生长曲线低于软骨发育不全标准生长曲线平均值的软骨发育不全患者被纳入S1。其余患者直接纳入S2。分析的变量包括人体测量、延长结果、困难程度和功能。
在该方案纳入的所有患者中，15例完成了S1和S2，4例仅完成了S2，2例仅完成了S1。S1前的身高和肢干比分别为107.65±7.14厘米和1.89±0.10，S1后的身高和肢干比分别为126.50±9.19厘米和1.64±0.09。S1时股骨和胫骨延长了14.43±1.41厘米，S2时肱骨延长了9.95±0.60厘米，S1的阶段愈合指数为18.23±3.54，S2为28.92±4.42。所有患者均实现了下肢角度偏差的矫正、功能改善以及并发症发生率可控。
本研究提出的肢体延长方案是治疗软骨发育不全患者以实现既定目标（肢干比、功能改善和下肢对线）的合适方法。该手术具有可重复性，且患者安全得到了保障。
