Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY.
J Am Acad Orthop Surg Glob Res Rev. 2020 Jun 12;4(6). doi: 10.5435/JAAOSGlobal-D-20-00054. eCollection 2020 Jun.
Integrated limb lengthening combines both internal and external fixation methods. It has been introduced to improve time to union, patient time in frame, risk of regenerate refracture, and patient function. We systematically review studies to assess whether integrated limb lengthening methods are superior to classic limb lengthening.
A total of 457 patients had classic limb lengthening, whereas 488 underwent integrated limb lengthening. The primary outcome measures were total length achieved (cm), external fixator index (month/cm) and bone healing index (month/cm). Problems, obstacles, and sequelae were compared using random effects meta-analyses of all available cases. Kaplan-Meier curves were generated to compare the time spent in frame.
Integrated limb lengthening demonstrated a superior external fixator index ( = 0.0001) and bone healing index ( = 0.0146). The mean time spent in frame for integrated lengthening was significantly shorter ( = 0.0015). Significantly fewer problems ( = 0.000) and sequelae ( = 0.001) were observed with integrated lengthening. Deep infections were more common in the integrated cohort. The lengthening over a nail deep infection rate was significantly higher than with the lengthening and then nailing and lengthening and then plating techniques ( = 0.005).
Integrated methods of limb lengthening are superior to classic methods. We suggest the integration of plates and nails with circular frames to improve outcomes in patients undergoing limb lengthening procedures.
综合肢体延长术结合了内固定和外固定两种方法。它的引入是为了改善愈合时间、患者在固定架中的时间、再生性再骨折的风险和患者的功能。我们系统地回顾了研究，以评估综合肢体延长方法是否优于经典肢体延长方法。
共有 457 例患者接受了经典肢体延长术，488 例患者接受了综合肢体延长术。主要的结局指标是达到的总长度（cm）、外固定指数（月/cm）和骨愈合指数（月/cm）。使用所有可用病例的随机效应荟萃分析比较了问题、障碍和后遗症。生成 Kaplan-Meier 曲线以比较在框架中花费的时间。
综合肢体延长术表现出更好的外固定指数（ = 0.0001）和骨愈合指数（ = 0.0146）。综合延长术的平均框架内时间明显缩短（ = 0.0015）。观察到的综合延长术的问题（ = 0.000）和后遗症（ = 0.001）明显较少。深感染在综合组中更为常见。在带有钉的延长术和随后的钉和延长术以及随后的板固定术的组中，延长术超过指甲深感染率明显更高（ = 0.005）。
综合肢体延长方法优于经典方法。我们建议将钢板和钉子与环形框架结合使用，以改善接受肢体延长手术的患者的治疗效果。
