成骨延长术联合单枚髓内伸缩钉在软骨发育不全症患者中的应用

Two-stage Bone Lengthening With Reuse of a Single Intramedullary Telescopic Nail in Patients With Achondroplasia.

机构信息

Limb Lengthening and Reconstruction Unit, Orthopaedic Surgery and Traumatology Department.

Department of Orthopaedic Surgery and Traumatology.

出版信息

J Pediatr Orthop. 2022 Jul 1;42(6):e616-e622. doi: 10.1097/BPO.0000000000002133. Epub 2022 Mar 7.

DOI:10.1097/BPO.0000000000002133

PMID:35250019

Abstract

BACKGROUND

Patients with achondroplasia may benefit from limb-lengthening surgery with telescopic intramedullary nails (TIMNs). However, the 5-cm maximum length of the nails used in these patients in their original design may be insufficient. The aim of this research is to analyze the outcomes and complications after reusing the same TIMN for a second consecutive 5-cm lengthening in patients with achondroplasia.

METHODS

Retrospective study of 26 bones (16 femurs and 10 tibias) in 9 patients with achondroplasia treated for bilateral 2-stage sequential lengthening reusing the same TIMN. On completion of a first stage of 5 cm of elongation, the nail was unlocked, retracted, and re-locked; a second stage of 5 cm of distraction followed. Radiologic and clinical parameters were measured preoperatively and postoperatively, and complications were recorded.

RESULTS

The median age of patients at first surgery was 13.54 (12.9 to 16.3) years; 55% were males. The median preoperative height was 121 (117.5 to 127) cm, and the median healing index was 18.12 (14.5 to 32.8) and 26.96 (23.3 to 31.6) d/cm, while time to weight bearing was 185.5 (144.8 to 308.5) and 242.5 (208.5 to 293.8) days for femurs and tibias, respectively. Major complications included 3 cases of moderate ankle equinus, 2 cases of hardware failure (failure to relengthen), 2 premature consolidations, 1 common peroneal neurapraxia, and 2 valgus deformities. Femoral procedures had significantly fewer complications than tibial interventions (7 vs. 15, P=0.03), whereas patients who underwent lengthening of both the femur and tibia did not have significantly higher complication rates (14 vs. 8, P=0.6).

CONCLUSIONS

This study analyzes lower-limb lengthening in a series of achondroplastic patients using TIMN with the novelty of nail reuse to relengthen the bone. The complication rate found is acceptable, among which, potential damage to the internal lengthening mechanism must be considered, though this complication can usually be easily resolved. Overall, nail reuse seems advisable in cases where bone elongation is indicated, and the size and design of the nail limits the extent of lengthening.

LEVEL OF EVIDENCE

Level III, retrospective comparative study, before and after intervention.

摘要

背景

成骨不全症患者可能受益于带有伸缩式髓内钉（TIMN）的肢体延长手术。然而，最初设计中用于这些患者的钉子最长 5 厘米可能不够长。本研究旨在分析在成骨不全症患者中，同一 TIMN 连续两次进行 5 厘米延长后，其结果和并发症。

方法

对 9 例成骨不全症患者的 26 根骨骼（16 根股骨和 10 根胫骨）进行回顾性研究，这些患者接受了双侧 2 期序贯延长手术，重新使用同一 TIMN。第一阶段延长 5 厘米后，将钉子解锁、缩回并重新锁定；随后进行第二阶段的 5 厘米的牵伸。测量术前和术后的影像学和临床参数，并记录并发症。

结果

首次手术时患者的中位年龄为 13.54 岁（12.9 至 16.3 岁）；55%为男性。术前中位身高为 121cm（117.5 至 127cm），愈合指数中位数为 18.12（14.5 至 32.8）和 26.96（23.3 至 31.6）d/cm，股骨和胫骨负重时间分别为 185.5 天（144.8 至 308.5 天）和 242.5 天（208.5 至 293.8 天）。主要并发症包括 3 例中度踝关节马蹄内翻、2 例内固定失败（无法再延长）、2 例过早愈合、1 例腓总神经麻痹和 2 例外翻畸形。股骨手术的并发症明显少于胫骨干预（7 例比 15 例，P=0.03），而同时行股骨和胫骨延长的患者的并发症发生率并没有显著增加（14 例比 8 例，P=0.6）。