Vogt Bjoern, Rupp Carolin, Gosheger Georg, Eveslage Maria, Laufer Andrea, Toporowski Gregor, Roedl Robert, Frommer Adrien
Paediatric Orthopaedics, Deformity Reconstruction, and Foot Surgery, Münster University Hospital, Münster, Germany.
General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany.
Bone Joint J. 2023 Jan;105-B(1):88-96. doi: 10.1302/0301-620X.105B1.BJJ-2022-0755.R1.
Distraction osteogenesis with intramedullary lengthening devices has undergone rapid development in the past decade with implant enhancement. In this first single-centre matched-pair analysis we focus on the comparison of treatment with the PRECICE and STRYDE intramedullary lengthening devices and aim to clarify any clinical and radiological differences.
A single-centre 2:1 matched-pair retrospective analysis of 42 patients treated with the STRYDE and 82 patients treated with the PRECICE nail between May 2013 and November 2020 was conducted. Clinical and lengthening parameters were compared while focusing radiological assessment on osseous alterations related to the nail's telescopic junction and locking bolts at four different stages.
Osteolysis next to the telescopic junction was observed in 31/48 segments (65%) lengthened with the STRYDE nail before implant removal compared to 1/91 segment (1%) in the PRECICE cohort. In the STRYDE cohort, osteolysis initially increased, but decreased or resolved in almost all lengthened segments (86%) after implant removal. Implant failure was observed in 9/48 STRYDE (19%) and in 8/92 PRECICE nails (9%). Breakage of the distal locking bolts was found in 5/48 STRYDE nails (10%) compared to none in the PRECICE cohort. Treatment-associated pain was generally recorded as mild and found in 30/48 patients (63%) and 39/92 (42%) in the STRYDE and PRECICE cohorts, respectively. Temporary range of motion (ROM) limitations under distraction were registered in 17/48 (35%) segments treated with the STRYDE and 35/92 segments (38%) treated with the PRECICE nail.
Osteolysis and periosteal reaction, implant breakage, and pain during lengthening and consolidation is more likely in patients treated with the STRYDE nail compared to the PRECICE nail. Temporary ROM limitations during lengthening occurred independent of the applied device. Implant-related osseous alterations seem to remodel after implant removal.Cite this article: 2023;105-B(1):88-96.
在过去十年中，髓内延长装置辅助的牵张成骨技术随着植入物的改进得到了快速发展。在这项首个单中心配对分析中，我们着重比较使用PRECICE和STRYDE髓内延长装置的治疗效果，旨在明确任何临床和放射学差异。
对2013年5月至2020年11月期间接受STRYDE治疗的42例患者和接受PRECICE髓内钉治疗的82例患者进行单中心2:1配对回顾性分析。比较临床和延长参数，同时在四个不同阶段对与髓内钉伸缩连接和锁定螺栓相关的骨质改变进行放射学评估。
在取出植入物前，使用STRYDE髓内钉延长的48个节段中有31个（65%）观察到伸缩连接旁骨溶解，而PRECICE队列中91个节段中有1个（1%）出现骨溶解。在STRYDE队列中，骨溶解最初增加，但在取出植入物后几乎所有延长节段（86%）中减少或消失。STRYDE组48例中有9例（19%）出现植入物失败，PRECICE组92例中有8例（9%）出现植入物失败。STRYDE组48例中有5例（10%）发现远端锁定螺栓断裂，而PRECICE队列中未发现。与治疗相关的疼痛一般记录为轻度，STRYDE组48例中有30例（63%）出现疼痛，PRECICE组92例中有39例（42%）出现疼痛。STRYDE治疗的48个节段中有17个（35%）和PRECICE髓内钉治疗的92个节段中有35个（38%）在牵张过程中出现临时活动范围（ROM）受限。
与PRECICE髓内钉相比，使用STRYDE髓内钉治疗的患者更易出现骨溶解和骨膜反应、植入物断裂以及延长和巩固过程中的疼痛。延长过程中的临时ROM受限与所使用的装置无关。植入物取出后，与植入物相关的骨质改变似乎会重塑。引用本文：2023；105-B(1):88-96。
