Department of Paediatric Orthopaedics and Traumatology, Poznań University of Medical Sciences, Poznań.
Department of Pediatric Surgery, Collegium Medicum, Jagiellonian University.
J Pediatr Orthop. 2021 Apr 1;41(4):e347-e352. doi: 10.1097/BPO.0000000000001763.
Although Fassier-Duval (FD) rods have been used for almost 2 decades, knowledge of factors predisposing to their failure is limited. Thus, the purpose of this study was to: (1) present the most common complications of FD rodding, (2) present tips on how to avoid or overcome them, and (3) identify factors predisposing to treatment failure.
Fifty-eight rod segments in 19 patients with osteogenesis imperfecta (mainly type III) underwent analysis with a median follow-up (FU) time of 4.4 years. We assessed the total number of complications clinically and radiographically. Next, the possible predisposing factors leading to failure were assessed using the Mann-Whitney U test. In addition, we evaluated the cutoff age for the increased rate of complications using the Youden index. A P<0.05 was considered significant.
The total number of complications reached 44.8%. The most common complications included: migration of the male or female implant (45.7% and 25.7% out of the total number of complications, respectively), bone fracture with bending of the rod (8.6%), and rotational deformities (8.6%). Significant differences in patients' ages at the time of surgery were found between the group with and without complications (P=0.04), while sex, segment treated, preceding surgeries, length of FU, FD rod diameter, and length of bisphosphonate treatment were not significant. The Youden index showed that the risk of complications rose significantly in patients treated when younger than 5.5 years of age (P<0.05).
This series displays the effectiveness and utility of FD rods at a median FU of over 4 years. Complication rates were comparable with the existing literature, with a notable increase in the number of side effects observed in younger patients (below the age of 5).
Level IV-therapeutic study.
尽管 Fassier-Duval（FD）棒已使用近 20 年，但导致其失败的相关因素仍知之甚少。因此，本研究的目的是：（1）介绍 FD 棒最常见的并发症；（2）介绍如何避免或克服这些并发症的技巧；（3）确定导致治疗失败的相关因素。
19 例成骨不全症（主要为 III 型）患者的 58 个棒段进行了分析，平均随访（FU）时间为 4.4 年。我们从临床和影像学两方面评估了总并发症数量。接下来，我们使用 Mann-Whitney U 检验评估导致失败的可能相关因素。此外，我们还使用 Youden 指数评估并发症发生率增加的截点年龄。P＜0.05 被认为有统计学意义。
并发症总数达到 44.8%。最常见的并发症包括：男性或女性植入物的迁移（分别占总并发症数的 45.7%和 25.7%）、棒弯曲导致的骨折（8.6%）和旋转畸形（8.6%）。在有并发症和无并发症的两组患者中，手术时的年龄存在显著差异（P=0.04），而性别、治疗节段、术前手术、FU 时间、FD 棒直径和双膦酸盐治疗时间无显著差异。Youden 指数显示，在小于 5.5 岁的患者中，并发症的风险显著增加（P＜0.05）。
本系列研究在超过 4 年的 FU 中位数中显示了 FD 棒的有效性和实用性。并发症发生率与现有文献相当，但在年龄较小（5 岁以下）的患者中观察到的副作用数量显著增加。
IV 级-治疗研究。
