Noonan K J, Leyes M, Forriol F
Department of Orthopaedic Surgery, Indiana University, Indianapolis 46202-5111, USA.
Iowa Orthop J. 1997;17:96-101.
We report the results and complications of eight consecutive patients who underwent bilateral tibial lengthenings for dwarfism associated with Turner syndrome. Lengthening was performed via distraction osteogenesis with monolateral external fixation. Tibias were lengthened an average distance of 9.2 centimeters or 33 percent of the original tibial length. The average total treatment time was 268 days. The overall complication rate was 169 percent for each tibia lengthened and each segment required an average of 1.7 additional procedures. Seven cases (44 percent) required Achilles tendon lengthening and nine cases (56 percent) developed angulation before or after fixator removal; six of these segments required corrective osteotomy for axial malalignment. Two cases (12.5 percent) developed distraction site nonunion and required plating and bone grafting. From this series we conclude that tibial lengthening via distraction osteogenesis can be used to treat disproportionate short stature in patients with Turner syndrome. However, the benefit of a cosmetic increase in height may not compensate for the high complication rate. Efforts to determine the psychosocial and functional benefits of limb lengthening in patients with short stature is necessary to determine the true cost-benefit ratio of this procedure.
我们报告了连续8例因特纳综合征相关侏儒症接受双侧胫骨延长术的患者的结果及并发症。延长术通过单侧外固定架进行牵张成骨。胫骨平均延长9.2厘米，占原胫骨长度的33%。平均总治疗时间为268天。每侧胫骨延长的总体并发症发生率为169%，每个节段平均需要额外进行1.7次手术。7例（44%）需要跟腱延长，9例（56%）在拆除固定架之前或之后出现成角；其中6个节段需要进行截骨矫正轴向畸形。2例（12.5%）出现牵张部位骨不连，需要进行钢板固定和植骨。从本系列研究我们得出结论，通过牵张成骨进行胫骨延长可用于治疗特纳综合征患者的不成比例性身材矮小。然而，身高增加带来的美容益处可能无法弥补高并发症发生率。确定身材矮小患者肢体延长的心理社会和功能益处的努力对于确定该手术的真正成本效益比是必要的。
