Iobst Christopher, Bafor Anirejuoritse, Herzenberg John E
Nationwide Children's Hospital, Columbus, OH, USA.
Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA.
J Pediatr Soc North Am. 2024 Apr 9;7:100056. doi: 10.1016/j.jposna.2024.100056. eCollection 2024 May.
Distraction osteogenesis describes the process of growing new bone ("regenerate") to correct limb length discrepancies or limb deformities. Whether pure lengthening or a combination of lengthening and straightening is involved, this represents one of the highest anabolic demands on bone in orthopedic surgery. Because distraction osteogenesis requires the formation of new bone, often in large amounts, it is critically important to evaluate the bone health of any potential surgical patient. Patients undergoing limb lengthening, therefore, would be expected to be especially sensitive to poor bone health. This article will review opportunities to assess and potentially improve bone health for limb lengthening patients.
(1)Many potential limb lengthening patients may be vitamin D deficient or insufficient.(2)Other simple nutraceuticals such as Boron, Magnesium, Calcium, Silicon, vitamin K, L-arginine, and Inositol should be considered as adjuncts to bone health.(3)Intra-operative technique such as minimally invasive incisions that protect the blood supply and periosteum combined with osteotomies that maximize the bone surface area are recommended.(4)Numerous proposed pharmacological and mechanical interventions to improve and accelerate the healing of the regenerate bone look promising but are still investigational.
牵张成骨描述了生长新骨（“再生”）以纠正肢体长度差异或肢体畸形的过程。无论涉及单纯延长还是延长与矫直相结合，这都是骨科手术中对骨骼合成代谢要求最高的情况之一。由于牵张成骨需要形成新骨，而且通常是大量新骨，因此评估任何潜在手术患者的骨骼健康至关重要。因此，预计接受肢体延长手术的患者对骨骼健康状况不佳会特别敏感。本文将综述评估并可能改善肢体延长患者骨骼健康的机会。
（1）许多潜在的肢体延长患者可能存在维生素D缺乏或不足的情况。（2）其他简单的营养保健品，如硼、镁、钙、硅、维生素K、L-精氨酸和肌醇，应被视为骨骼健康的辅助补充剂。（3）建议采用术中技术，如保护血供和骨膜的微创切口，以及能使骨表面积最大化的截骨术。（4）众多旨在改善和加速再生骨愈合的药物和机械干预措施虽前景可期，但仍处于研究阶段。
