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骨内截骨术和牵张成骨术治疗 Ollier 病肢体长度均衡的疗效

Outcomes of intralesional osteotomy and distraction osteogenesis for limb length equalization in Ollier's disease.

作者信息

Hosny Gamal A, Elsheikh Ahmed A

机构信息

Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Egypt.

出版信息

J Pediatr Orthop B. 2023 Jan 1;32(1):54-59. doi: 10.1097/BPB.0000000000001001.

Abstract

Limb length discrepancy and deformities resulting from Ollier's disease are challenging to treat and have increased complications. We aimed to assess the safety of intralesional osteotomy for distraction osteogenesis and report the results of guided growth as a method of deformity correction in such conditions. We retrospectively reviewed 13 patients (eight boys and five girls), 28 segments (12 femora and 16 tibias), treated using Ilizarov circular ring fixator in one center. Nine patients had an oblique plane deformity, whereas four had a coronal plane deformity. Femoral shortening ranged from three to 11 cm. Tibial shortening ranged from 3.5 to 12 cm. Intralesional osteotomy was carried out in all patients, and guided growth (hemiepiphysiodesis) was used in seven segments (25%). The median age was 11 years (6-14 years) at surgery, with a median follow-up of 4.5 years (3-18 years). The median achieved lengthening in the femur was 7 cm (5-11 cm) and in the tibia was 5 cm (3-9 cm). The average Bone Healing Index (BHI) for the femur was 32 days/cm (28-38 days/cm), and for the tibia was 36 days/cm (28-40 days/cm). Before frame removal, the mechanical axis was restored to the knee joint center in all cases. Normal radiographic bone regeneration was evident in all cases. Hemiepiphysiodesis successfully corrected the angular deformities. Intralesional osteotomy for distraction osteogenesis is well-tolerated and reliable in Ollier's disease. Radiological normal bone was formed at the distraction site. Guided growth is also a reproducible method for deformity correction in Ollier's disease, similar to other conditions.

摘要

骨软骨瘤病导致的肢体长度差异和畸形治疗具有挑战性,且并发症增多。我们旨在评估病灶内截骨延长成骨术的安全性,并报告引导生长作为此类情况下畸形矫正方法的结果。我们回顾性分析了在一个中心使用伊里扎洛夫环形固定器治疗的13例患者(8例男孩和5例女孩)、28个节段(12个股骨和16个胫骨)。9例患者存在斜平面畸形,4例存在冠状面畸形。股骨短缩范围为3至11厘米。胫骨短缩范围为3.5至12厘米。所有患者均进行了病灶内截骨,7个节段(25%)采用了引导生长(半骨骺阻滞术)。手术时的中位年龄为11岁(6至14岁),中位随访时间为4.5年(3至18年)。股骨的中位延长长度为7厘米(5至11厘米),胫骨为5厘米(3至9厘米)。股骨的平均骨愈合指数(BHI)为32天/厘米(28至38天/厘米),胫骨为36天/厘米(28至40天/厘米)。在拆除固定架之前,所有病例的机械轴均恢复至膝关节中心。所有病例均可见正常的放射学骨再生。半骨骺阻滞术成功矫正了角状畸形。病灶内截骨延长成骨术在骨软骨瘤病中耐受性良好且可靠。在牵张部位形成了放射学上的正常骨。引导生长也是骨软骨瘤病中一种可重复的畸形矫正方法,与其他情况类似。

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