Depaoli Alessandro, Magnani Marina, Casamenti Agnese, Ramella Marco, Menozzi Grazia Chiara, Gallone Giovanni, Viotto Marianna, Rocca Gino, Trisolino Giovanni
Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
Children (Basel). 2024 Oct 30;11(11):1322. doi: 10.3390/children11111322.
Lower limb length discrepancy (LLD) in children and adolescents, often due to congenital or acquired conditions, is treated to achieve limb equality and alignment, optimizing function and minimizing cosmetic concerns for an active adulthood. This study evaluated the Health-Related Quality of Life (HRQoL) and physical functioning of adults who underwent unilateral limb lengthening with circular external fixators (EFs) in childhood.
Fifty patients treated at a median age of 14.9 years completed the Short Form 36 (SF-36) and Stanmore Limb Reconstruction Score (SLRS) questionnaires in adulthood, with a median follow-up of 8.9 years.
Among the 50 patients, 38 underwent a single limb lengthening (21 tibia, 12 femur, 5 both), while 12 required multiple cycles. The median residual LLD was 0.4 cm, with 12 patients (24%) having over 2 cm. Complications occurred in 67% of procedures, mainly due to prolonged healing. Physical and mental health scores were significantly lower than normative data. The mean Physical Component Summary was 52.2 ± 7.2 ( = 0.20). The mean Mental Component Summary was 43.9 ± 8.6 ( = 0.001), notably lower in congenital LLD cases. Many SLRS items (Pain, Social, Physical Function, Work, and Emotions) strongly correlated with SF-36 items.
Adults treated with distraction osteogenesis for congenital LLD show normal physical but lower mental health scores compared to peers. Lengthening procedure characteristics did not significantly impact mental health. Routine psychological and social assessments are recommended to prevent long-term distress by providing appropriate support.
儿童和青少年下肢长度不等（LLD）通常由先天性或后天性疾病引起，治疗目的是实现双下肢等长和对线，优化功能并尽量减少对活跃成年期的外观影响。本研究评估了童年期接受环形外固定器（EFs）单侧肢体延长术的成年人的健康相关生活质量（HRQoL）和身体功能。
50例患者接受治疗时的中位年龄为14.9岁，成年后完成了简短健康调查问卷（SF-36）和斯坦莫尔肢体重建评分（SLRS）问卷，中位随访时间为8.9年。
50例患者中，38例接受了单次肢体延长术（21例胫骨，12例股骨，5例两者均有），而12例需要多个周期。残余LLD的中位数为0.4 cm，12例患者（24%）超过2 cm。67%的手术发生了并发症，主要原因是愈合时间延长。身体和心理健康评分显著低于标准数据。身体成分总结平均分为52.2±7.2（ = 0.20）。心理成分总结平均分为43.9±8.6（ = 0.001），在先天性LLD病例中明显更低。许多SLRS项目（疼痛、社交、身体功能、工作和情绪）与SF-36项目密切相关。
与同龄人相比，接受牵张成骨术治疗先天性LLD的成年人身体状况正常，但心理健康评分较低。延长手术的特征对心理健康没有显著影响。建议进行常规的心理和社会评估，通过提供适当的支持来预防长期痛苦。
