Van Nguyen Luong
Institute of Trauma and Orthopaedics, 108 Central Military Hospital, Hanoi, Viet Nam.
Int J Surg Case Rep. 2023 Mar;104:107961. doi: 10.1016/j.ijscr.2023.107961. Epub 2023 Mar 4.
The management of extreme limb-length discrepancy remains a challenge for surgeons. Limb lengthening using an external fixator is a popular method for managing limb-length discrepancy; however, it had many complications. Other techniques using external fixators have been described, such as lengthening over a nail (LON) technique and lengthening and then plating (LATP), which decrease external fixator duration, equinus contracture, pin-site infection, bone alignment, and bone fracture. Only a few cases of management of extreme limb-length discrepancy due to hip dysplasia using LATP and LON techniques are reported in the literature.
We report a 24-year-old case of an 18 cm lower limb length discrepancy, who had tibial lengthening and Chiari pelvic osteotomy for treatment of congenital hip dislocation 12 years ago. The treatment for the patient was underwent the lengthening over nail technique in the tibia and lengthening and then plating in the femur. 9 months post-operative, the tibia and femur are union. The patient reported no pain and could walk and climb stairs without a crutch.
Following pelvic osteotomy, leg lengthening is a good treatment for limb-length discrepancy due to hip dysplasia. The LON technique or LATN in the tibia and in the femur is an alternative choice for the treatment of extreme limb-length discrepancy. Lengthening and then plating could be widely employed in patients who are not suitable for the LON technique. Although the patient had gained the 18 cm lengthening, the range of motion of the left knee joint and left ankle joint was unrestricted, and without neurovascular complication.
Following pelvic osteotomy, LON technique in the tibia and or LATP in the femur is considered an alternative choice for the treatment of extreme limb-length discrepancy due to hip dysplasia. LATP should be widely employed in patients who are not suitable for limb lengthening over a nail.
A case report.
极重度肢体长度差异的治疗对外科医生来说仍是一项挑战。使用外固定器进行肢体延长是治疗肢体长度差异的常用方法；然而，该方法存在许多并发症。已描述了其他使用外固定器的技术，如经髓内钉延长（LON）技术和先延长再钢板固定（LATP）技术，这些技术可缩短外固定器使用时间、减少马蹄足挛缩、针道感染、改善骨对线并降低骨折风险。文献中仅报道了少数几例使用LATP和LON技术治疗因髋关节发育不良导致的极重度肢体长度差异的病例。
我们报告一例24岁患者，下肢长度差异达18厘米，12年前因先天性髋关节脱位接受了胫骨延长和Chiari骨盆截骨术。该患者接受了胫骨经髓内钉延长技术和股骨先延长再钢板固定治疗。术后9个月，胫骨和股骨均已愈合。患者报告无疼痛，无需拐杖即可行走和爬楼梯。
骨盆截骨术后，肢体延长是治疗因髋关节发育不良导致的肢体长度差异的良好方法。胫骨和股骨采用LON技术或LATN技术是治疗极重度肢体长度差异的另一种选择。先延长再钢板固定可广泛应用于不适合LON技术的患者。尽管患者实现了18厘米的延长，但左膝关节和左踝关节的活动范围不受限，且无神经血管并发症。
骨盆截骨术后，胫骨采用LON技术和/或股骨采用LATP技术被认为是治疗因髋关节发育不良导致的极重度肢体长度差异的另一种选择。LATP应广泛应用于不适合经髓内钉延长的患者。
病例报告。
