Zionts L E, Ebramzadeh E, Stott N S
Division of Pediatric Orthopaedics, Women's and Children's Hospital, Los Angeles, CA 90027, USA.
Clin Orthop Relat Res. 1998 Mar(348):186-95.
The results of 40 extensible intramedullary nailing procedures in 15 children who had osteogenesis imperfecta were reviewed to identify risk factors leading to complications of this method of treatment. There were 40 complications, 17 major and 23 minor. The 17 major complications led to 15 additional procedures, 10 of which were to remove or replace the implant. The prevalence of major complications was highest in patients who were younger than 5 years when the nail was inserted. Nails placed in the tibia tended to produce a higher incidence of major complications than did those placed in the femur, but this difference was not statistically significant. By survivorship analysis, patients had a greater risk of requiring a revision procedure when a technical error occurred at the time the nail was inserted. Patients who had nails placed in the femur tended to have a lower risk of needing revision surgery than did those who had nails placed in the tibia, but this difference was not statistically significant. The results suggested that the extensible nail is most advantageous in the femur and in patients older than 5 years. Avoiding technical errors when inserting the nail may improve the longevity of the device.
回顾了15例患有成骨不全症儿童的40次可延长髓内钉固定手术的结果，以确定导致这种治疗方法出现并发症的风险因素。共有40例并发症，其中17例为严重并发症，23例为轻微并发症。17例严重并发症导致另外15次手术，其中10次是取出或更换植入物。在插入髓内钉时年龄小于5岁的患者中，严重并发症的发生率最高。置于胫骨的髓内钉产生严重并发症的发生率往往高于置于股骨的髓内钉，但这种差异无统计学意义。通过生存分析，在插入髓内钉时发生技术错误的患者需要翻修手术的风险更大。置于股骨的髓内钉患者需要翻修手术的风险往往低于置于胫骨的髓内钉患者，但这种差异无统计学意义。结果表明，可延长髓内钉在股骨和5岁以上患者中最具优势。插入髓内钉时避免技术错误可能会提高该装置的使用寿命。
