Shabtai Lior, Jauregui Julio J, Herzenberg John E, Gesheff Martin G, Standard Shawn C, McClure Philip K
Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA.
Department of Orthopaedics, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201, USA.
Children (Basel). 2021 Aug 30;8(9):749. doi: 10.3390/children8090749.
Previous studies on lengthening for achondroplasia have reported bilateral extensive femoral lengthening followed by bilateral extensive tibial lengthening. To decrease trauma on soft tissues and joints, we propose bilateral simultaneous moderate femoral lengthening and moderate tibial lengthening followed by a similar repeat lengthening a few years later. Fifty patients with achondroplasia underwent 65 simultaneous bilateral femoral and tibial lengthening procedures. Segment lengthening amount and adverse events were obtained from medical records. Mean follow-up after bone healing was 35.6 months. Mean tibial lengthening was 52 mm; mean femoral lengthening was 72 mm. Average healing index was 1.4 months/cm for the tibia and 1 month/cm for the femur. Mean duration of treatment with external fixation was 6.7 months (range, 4.4-10.5 months). Thirty-eight (76%) of 50 patients experienced one or more adverse events during lengthening. We observed 78 adverse events, 35 (45%) of which required additional surgical procedures. All resolved by the end of treatment. Mechanical axis deviation improved from a mean of 15 mm medially to 8 mm medially. Simultaneous lengthening of four segments in patients with achondroplasia is a feasible strategy. Compared with isolated femoral or tibial lengthening, distributing the lengthening between the femur and tibia decreases total external fixator time.
以往关于软骨发育不全延长术的研究报告了双侧广泛股骨延长术，随后进行双侧广泛胫骨延长术。为减少对软组织和关节的创伤，我们建议进行双侧同时适度股骨延长术和适度胫骨延长术，几年后再进行类似的重复延长术。50例软骨发育不全患者接受了65次双侧股骨和胫骨同时延长手术。从病历中获取节段延长量和不良事件。骨愈合后的平均随访时间为35.6个月。平均胫骨延长52mm；平均股骨延长72mm。胫骨的平均愈合指数为1.4个月/cm，股骨为1个月/cm。外固定治疗的平均持续时间为6.7个月（范围4.4 - 10.5个月）。50例患者中有38例（76%）在延长过程中经历了一种或多种不良事件。我们观察到78例不良事件，其中35例（45%）需要额外的手术治疗。所有不良事件在治疗结束时均得到解决。机械轴偏差从平均内侧15mm改善至内侧8mm。软骨发育不全患者同时进行四个节段的延长是一种可行的策略。与单独的股骨或胫骨延长相比，将延长分布在股骨和胫骨之间可减少总的外固定时间。
