儿童股骨延长术：机动髓内钉与外固定技术的比较。

Femoral Lengthening in Children: A Comparison of Motorized Intramedullary Nailing Versus External Fixation Techniques.

机构信息

Hospital for Sick Children, Toronto, Ontario, Canada.

出版信息

J Pediatr Orthop. 2022;42(5):253-259. doi: 10.1097/BPO.0000000000002120.

DOI:10.1097/BPO.0000000000002120

PMID:35180729

Abstract

BACKGROUND

Femoral lengthening is associated with high complication rates often related to the type of surgical device used to perform the lengthening. The advent of intramedullary lengthening devices has promised a reduction in complications when compared with external fixation systems. The purpose of this study was to compare the clinical outcomes of femoral lengthening in children using a motorized intramedullary nail (Precice) versus an external fixation system (Taylor Spatial Frame-TSF; or Monolateral Rail System-MRS) at a single institution, single surgeon practice.

METHODS

This study is a retrospective comparison of pediatric patients who had previously undergone femoral lengthening (±deformity correction). Patients ages 8 to 18 years of age were included and grouped based on whether they had undergone Precice nailing or external fixation (TSF or MRS) between 2010 and 2019.

RESULTS

Twenty-seven patients (32 femurs) were included. Thirteen patients (15 femurs) had undergone Precice nailing and 14 patients (17 femurs) had undergone external fixation. The Precice group had significantly fewer problems, obstacles, and complications than the external fixation group, Precice 6.6%, 0%, 0%, respectively, and external fixation 47.1%, 29.4%, 0% respectively (P<0.01). Unplanned return to the operating room occurred in 4 cases, solely in the external fixation group. There were no differences in percentage of goal length achieved, Precice (mean 93.6%, range: 66.7% to 114.3%), external fixation (mean 96%, range: 76.9% to 117.5%) P=0.31 and total length achieved, Precice (mean: 44 mm, range: 20 to 80 mm), external fixation (mean: 46 mm, range: 10 to 70 mm) P=0.72. There was no difference in consolidation index, Precice (24.1 d/cm), external fixation (28.5 d/cm) P=0.36. The Precice group had a significantly shorter length of stay (mean: 2.2 d, range: 1 to 4 d), compared with the external fixation group (mean: 3.7 d, range: 2 to 8), P=0.01.

CONCLUSIONS

Femoral lengthening in children using a motorized intramedullary nail was associated with a markedly reduced rate of complications and shorter length of stay compared with external fixation.

LEVEL OF EVIDENCE

Level III.

摘要

背景

股骨延长术与高并发症发生率相关，且常与用于进行延长术的手术器械类型有关。髓内延长器械的出现承诺与外固定系统相比可降低并发症发生率。本研究的目的是在单机构、单外科医生实践中比较使用动力髓内钉（Precice）与外固定系统（Taylor 空间框架-TSF；或单侧轨道系统-MRS）进行儿童股骨延长的临床结果。

方法

这是一项回顾性比较研究，纳入了此前接受过股骨延长术（+畸形矫正）的儿科患者。纳入年龄为 8 至 18 岁的患者，并根据他们在 2010 年至 2019 年间是否接受过 Precice 钉钉或外固定（TSF 或 MRS）进行分组。

结果

共纳入 27 例患者（32 条股骨）。13 例患者（15 条股骨）接受了 Precice 钉钉治疗，14 例患者（17 条股骨）接受了外固定治疗。与外固定组相比，Precice 组的问题、障碍和并发症明显更少，分别为 Precice 组 6.6%、0%、0%，而外固定组为 47.1%、29.4%、0%（P<0.01）。仅在外固定组中，有 4 例患者出现了计划外再次返回手术室的情况。目标长度达成率无差异，Precice 组（平均 93.6%，范围：66.7%至 114.3%），外固定组（平均 96%，范围：76.9%至 117.5%），P=0.31；总长度达成率也无差异，Precice 组（平均：44mm，范围：20 至 80mm），外固定组（平均：46mm，范围：10 至 70mm），P=0.72。骨痂指数也无差异，Precice 组（24.1d/cm），外固定组（28.5d/cm），P=0.36。与外固定组相比，使用动力髓内钉的 Precice 组的住院时间明显缩短（平均：2.2d，范围：1 至 4d），外固定组（平均：3.7d，范围：2 至 8d），P=0.01。