Makvana Sonia, Robertson A, Britten S, Calder P
The Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.
Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom.
Strategies Trauma Limb Reconstr. 2024 May-Aug;19(2):61-66. doi: 10.5005/jp-journals-10080-1616. Epub 2024 Aug 14.
The consent process involves supported decision-making between the surgeon and the patient. Both potential benefits and material risks of the procedure require explanation, with adequate time for reflection. The complexity of limb reconstruction surgery includes the potential for multiple types of complications. In an attempt to delineate the material risks in lower limb lengthening, a literature review was undertaken to ascertain the published rates of complications.
A review of articles from 2003 to 2023 via PubMed and Google Scholar, including keywords 'lengthening', 'tibia', 'lengthening nail' and 'external fixator' was undertaken. Studies with a minimum of 20 patients, undergoing lengthening of the femur, tibia, or both by an external fixator and/or an intramedullary lengthening nail were included for analysis. Complications were reported according to Paley's problems, obstacles, and complications.
Twenty-two papers met the inclusion criteria. The commonest complications listed following lengthening using an external fixator were pin site infections (52% in the femur and 18.8% in the tibia), delayed consolidation (8.3%), bone re-fracture (13%), and joint stiffness (18.8%). Following femoral lengthening using the intramedullary lengthening nails reported complication rates were lower, including implant issues (8%) and delayed consolidation (6%).
Patients require a full understanding of both benefits and potential harms when undergoing any surgical intervention. Our study has identified the published rates of complications following lower limb lengthening. These figures can be used to guide the consultation and enable surgeons to audit their own surgical results against the published literature.
Makvana S, Robertson A, Britten S, Consent in Limb Lengthening Surgery: Predicting the True Incidence of Material Risk. Strategies Trauma Limb Reconstr 2024;19(2):61-66.
同意过程涉及外科医生与患者之间的支持性决策。手术的潜在益处和物质风险都需要解释，并给予足够的时间进行思考。肢体重建手术的复杂性包括多种并发症的可能性。为了试图描述下肢延长手术中的物质风险，进行了一项文献综述以确定已发表的并发症发生率。
通过PubMed和谷歌学术搜索2003年至2023年的文章，关键词包括“延长”“胫骨”“延长钉”和“外固定器”。纳入至少20例接受股骨、胫骨或两者同时通过外固定器和/或髓内延长钉进行延长手术的患者的研究进行分析。并发症按照佩利的问题、障碍和并发症进行报告。
22篇论文符合纳入标准。使用外固定器延长后列出的最常见并发症是针道感染（股骨为52%，胫骨为18.8%）、延迟愈合（8.3%）、再骨折（13%）和关节僵硬（18.8%）。使用髓内延长钉进行股骨延长后报告的并发症发生率较低，包括植入物问题（8%）和延迟愈合（6%）。
患者在接受任何手术干预时都需要充分了解益处和潜在危害。我们的研究确定了下肢延长手术后已发表的并发症发生率。这些数据可用于指导会诊，并使外科医生能够根据已发表的文献审核自己的手术结果。
马克瓦纳S、罗伯逊A、布里顿S，《肢体延长手术中的同意：预测物质风险的真实发生率》。《创伤肢体重建策略》2024；19(2)：61 - 66。
