Department of Orthopaedic Surgery, The Alfred, 55 Commercial Rd, Melbourne 3004, Australia.
Department of Orthopaedic Surgery, The Alfred, 55 Commercial Rd, Melbourne 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred, 55 Commercial Rd, Melbourne 3004, Australia.
Injury. 2020 Apr;51(4):1091-1096. doi: 10.1016/j.injury.2020.03.004. Epub 2020 Mar 2.
Limb length discrepancy in adults is not an uncommon occurrence following trauma and limited literature exists on limb lengthening in skeletally mature populations using modern techniques. This study aimed to evaluate outcomes of limb lengthening surgery using the PRECICE magnetic limb lengthening intramedullary nail in an adult population.
From 2013 to 2018, 21 adult patients were operated by a single surgeon, using the PRECICE nail, for lower limb length discrepancies. Low energy femoral osteotomies were performed via a limited approach. Tibial osteotomies were performed using a percutaneous technique and Gigli saw. A distraction rate of 0.75 mm/day was used as a standard protocol with change in rate of 0.25 mm/day implemented as required. Patients were followed up until radiological evidence of consolidation.
Mean patient age was 36.4 years (range 21-65), with 19 patients being male. Seventeen femoral and four tibial lengthenings were performed. Mean follow up was 15.1 months (range 6-30). Eleven patients underwent deformity correction at time of nail insertion (10 femoral, 1 tibial). All patients achieved correct lengthening (mean gain 36.5 mm, range 18-80 mm). All patients consolidated their regenerate bone (mean 268 days, range 99-825). Mean femoral consolidation index was 6.5, mean tibial consolidation index was 16.1 (p = 0.002). Six patients had delayed consolidation of regenerate bone. Increasing age (p = 0.04), number of prior operations (p = 0.03), and smoking (p = 0.01) were associated with delayed consolidation. Four of 21 (19%) patients suffered a complication, with one implant failure.
The PRECICE intramedullary nail is a reliable limb lengthening device in skeletally mature patients, providing predictable lengthening and bone regeneration.
成人创伤后肢体长度差异并不少见，而使用现代技术对骨骼成熟人群进行肢体延长的文献有限。本研究旨在评估 PRECICE 磁力肢体延长髓内钉在成人人群中进行肢体延长手术的结果。
2013 年至 2018 年，一位外科医生对 21 例成人下肢长度差异患者进行了手术，使用 PRECICE 钉进行治疗。通过微创方法进行低能量股骨截骨术。胫骨截骨术采用经皮技术和 Gigli 锯进行。标准方案使用 0.75mm/天的牵伸率，必要时可将速率改为 0.25mm/天。患者在影像学证实骨愈合后进行随访。
患者平均年龄为 36.4 岁（范围 21-65 岁），其中 19 例为男性。17 例股骨延长和 4 例胫骨延长。平均随访时间为 15.1 个月（范围 6-30 个月）。11 例患者在钉插入时进行了畸形矫正（10 例股骨，1 例胫骨）。所有患者均实现了正确的延长（平均增加 36.5mm，范围 18-80mm）。所有患者的再生骨均愈合（平均愈合时间为 268 天，范围 99-825 天）。股骨平均愈合指数为 6.5，胫骨平均愈合指数为 16.1（p=0.002）。6 例患者再生骨延迟愈合。年龄增加（p=0.04）、既往手术次数增加（p=0.03）和吸烟（p=0.01）与延迟愈合相关。21 例患者中有 4 例（19%）发生并发症，其中 1 例出现植入物失败。
PRECICE 髓内钉是骨骼成熟患者可靠的肢体延长装置，可提供可预测的延长和骨再生。
