Reif Taylor J, Khabyeh-Hasbani Nathan, Buksbaum Joshua, Sheridan Gerard A, Hoellwarth Jason S, Fragomen Austin T, Rozbruch S Robert
From the Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY (Dr. Reif, Dr. Hoellwarth, Dr. Fragomen, and Dr. Rozbruch); the Hospital for Special Surgery, New York, NY (Mr. Khabyeh-Hasbani and Dr. Buksbaum); and the Department of Orthopaedics (Dr. Sheridan), University of Galway, Galway, Ireland.
J Am Acad Orthop Surg Glob Res Rev. 2025 May 22;9(6). doi: 10.5435/JAAOSGlobal-D-25-00118. eCollection 2025 Jun 1.
The time required to form new bone is a critical aspect of bone lengthening but is not constant depending on the osteotomy location. The objective of this study was to establish the bone healing index (BHI) after femur and tibia bone lengthening procedures. Additional objectives included identifying procedure-related complications and implant reliability.
A retrospective analysis was conducted on all consecutive internal lengthening nails (Precice; Nuvasive) implanted in the femur or tibia at a single institution from September 2012 to November 2019. Groups were delineated by surgical approach (antegrade femur [AF], retrograde femur [RF], or antegrade tibia [AT]). The primary outcome was the BHI (days to consolidate regenerate per centimeter bone lengthened). Additional outcomes included iatrogenic bone deformity, implant complications, and nail reliability. Comparative analysis of demographic characteristics and complications was conducted using chi-square tests, and BHI was compared using independent t-tests. Multivariate analysis was used to evaluate independent outcomes among the groups. Statistical significance was set at P < 0.05.
Of 286 bone lengthening events (164 AF, 67 RF, 55 AT), BHI was significantly lower for AF at 24.5 ± 9.5 d/cm than for RF at 33.5 ± 14.5 d/cm and AT at 41.0 ± 17.4 d/cm (P = 0.001) and lower for RF than for AT (P = 0.012). After multivariate analysis, nail approach (AF), younger age (≤16), and lengthening for stature (versus deformity) were significantly associated with a lower BHI. Lengthening > 3 cm was also associated with better BHI. Iatrogenic deformity was induced in 8/164 = 4.9% AF, 2/67 = 3.0% RF, and 5/55 = 9.1% AT. Implant reliability was 92.7% for AF, 93.1% for RF, and 94.8% for AT. Complications requiring another surgery were observed in 39 of 286 (13.6%), and failure to achieve the lengthening goal was observed in 1 of 286 (0.3%).
AF lengthening, younger age, stature lengthening, and lengthening > 3 cm lead to better bone healing indices using the Precice internal lengthening nail. Complications and iatrogenic deformity can be partially mitigated with surgeon-controlled decisions (surgical approach, blocking screws, distraction rate, weight-bearing restrictions) and rarely lead to a failure in achieving the lengthening goal if treated promptly.
III.
形成新骨所需的时间是骨延长的一个关键方面，但并非恒定不变，这取决于截骨部位。本研究的目的是确定股骨和胫骨延长术后的骨愈合指数（BHI）。其他目标包括识别与手术相关的并发症和植入物的可靠性。
对2012年9月至2019年11月在单一机构植入股骨或胫骨的所有连续的内置延长钉（Precice；纽唯思）进行回顾性分析。根据手术入路（顺行股骨[AF]、逆行股骨[RF]或顺行胫骨[AT]）进行分组。主要结局是BHI（每延长1厘米骨再生所需的巩固天数）。其他结局包括医源性骨畸形、植入物并发症和钉子的可靠性。使用卡方检验对人口统计学特征和并发症进行比较分析，使用独立t检验比较BHI。采用多变量分析评估各组之间的独立结局。设定统计学显著性为P<0.05。
在286例骨延长事件中（164例AF、67例RF、55例AT），AF组的BHI显著低于RF组和AT组，AF组为24.5±9.5天/厘米，RF组为33.5±14.5天/厘米，AT组为41.0±17.4天/厘米（P=0.001），RF组低于AT组（P=0.012）。多变量分析后，钉子入路（AF）、年龄较小（≤16岁）以及为身高延长（相对于畸形矫正）与较低的BHI显著相关。延长>3厘米也与较好的BHI相关。医源性畸形在AF组中的发生率为8/164 = 4.9%，RF组为2/67 = 3.0%，AT组为5/55 = 9.1%。AF组的植入物可靠性为92.7%，RF组为93.1%，AT组为9,4.8%。在这286例中，有39例（13.6%）出现需要再次手术的并发症，有1例（0.3%）未达到延长目标。
使用Precice内置延长钉进行AF延长、年龄较小、身高延长以及延长>3厘米可带来更好的骨愈合指数。通过外科医生控制的决策（手术入路、阻挡螺钉、牵张速率、负重限制），并发症和医源性畸形可得到部分缓解，且如果及时治疗，很少会导致无法实现延长目标。
III级
