Saleh M, Goonatillake H D
University of Sheffield, University Department of Orthopaedics, England.
J Pediatr Orthop B. 1995;4(2):150-8. doi: 10.1097/01202412-199504020-00006.
The principles of treatment of congenital leg length inequality include three strategies: joint stabilization, axis correction, and limb length equalization. We believe that early axis correction is important for normal musculoskeletal development and that residual deformity may be self-perpetuating. Of 97 lower limbs assessed, 14 had PFFD alone, 6 fibula hemimelia alone, and 49 a combination of the two. Seventy-four limb segments were operated on, including 29 joint stabilizations, 65 axis corrections, and 62 lengthenings. Axis correction was the commonest procedure in the under-five age group and may be performed alone or in combination with another treatment strategy. The average lengthening achieved was 4 cm representing a 15.75% length increase. The mean bone healing index was 54.25 days/cm, slightly more in the tibia than in the femur. We recommend early axis correction and joint stabilization prior to lengthening. The choice of lengthening technique depends on the preexisting risk factors and lengthenings should be short and frequent.
关节稳定、轴线矫正和肢体长度均衡。我们认为早期轴线矫正对正常肌肉骨骼发育很重要，而且残余畸形可能会自我持续存在。在评估的97条下肢中，14条仅患有先天性股骨缺如，6条仅患有半侧腓骨缺如，49条为两者合并。对74个肢体节段进行了手术，包括29次关节稳定手术、65次轴线矫正手术和62次延长手术。轴线矫正手术是五岁以下年龄组最常见的手术，可单独进行或与另一种治疗策略联合进行。平均延长长度为4厘米，代表长度增加了15.75%。平均骨愈合指数为54.25天/厘米，胫骨略高于股骨。我们建议在延长手术前进行早期轴线矫正和关节稳定。延长技术的选择取决于先前存在的风险因素，延长手术应短小且频繁进行。
