Femoral Lengthening with Lengthening over a Nail has Fewer Complications than Intramedullary Skeletal Kinetic Distraction

被引:58
作者
Mahboubian, Shahab [1 ]
Seah, Matthew [1 ]
Fragomen, Austin T. [1 ]
Rozbruch, S. Robert [1 ]
机构
[1] Hosp Special Surg, Limb Lengthening & Complex Reconstruct Serv, New York, NY 10021 USA
关键词
LEG LENGTH; CLASSIFICATION; RELIABILITY;
D O I
10.1007/s11999-011-2204-4
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Lengthening over a nail and internal lengthening nails have been developed to minimize or eliminate patients' time wearing a frame during femur lengthening. However it is unclear whether either of these two approaches results in faster times to union or fewer complications over the other. We asked which technique better achieved: (1) the lengthening goals, (2) the distraction rate control, (3) quality of the regenerate bone, (4) fewer complications, and (5) if SF-36 scores and American Academy of Orthopaedic Surgeons Lower Limb Module (AAOS LLM) scores differ in each treatment modality? We retrospectively reviewed the records and radiographs of 11 patients who had 12 Intramedullary Skeletal Kinetic Distractor (ISKD) procedures between 2002 and 2005, and 21 patients with 22 femoral lengthenings performed as lengthening over nail procedures between 2005 and 2009. Details such as leg length discrepancies, operative time, time of removal of the external fixator or ISKD, and any complications encountered were recorded. SF-36 and AAOS LLM scores also were compiled. The minimum followups for the ISKD and the lengthening over nail cohorts were 62 months (average, 76 months; range, 62-93 months) and 13 months (average, 27 months; range, 13-38 months), respectively. We observed no difference in achieving the lengthening goals between the two procedures. Distraction was not well controlled in the ISKD group; the distraction rates were 1.7 mm per day for the fast group (distraction rate greater than 1 mm/day) and 0.84 mm per day for the slow group (less than 1 mm/day). The lengthening over nail group had an average distraction rate of 0.88 mm per day. One of 20 of the patients who had lengthening over a nail had complications requiring additional unanticipated surgeries whereas six of 12 patients who had femoral lengthening in the ISKD group had such complications. Based on our observations, we believe the lengthening over nail technique for femoral lengthening is associated with fewer complications than the ISKD. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
引用
收藏
页码:1221 / 1231
页数:11
相关论文
共 29 条
[1]   Interobserver and intraobserver reliability of radiographic evidence of bone healing at osteotomy sites [J].
Anand, Ashish ;
Feldman, David S. ;
Patel, Raviraj J. ;
Lehman, Wallace B. ;
van Bosse, Harold J. P. ;
Badra, Mohammod I. ;
Sala, Debra A. .
JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B, 2006, 15 (04) :271-272
[2]   Mechanical failure of the Intramedullary Skeletal Kinetic Distractor in limb lengthening [J].
Burghardt, R. D. ;
Herzenberg, J. E. ;
Specht, S. C. ;
Paley, D. .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 2011, 93B (05) :639-643
[3]   Limb lengthening over a nail can safely reduce the duration of external fixation [J].
Chaudhary, Milind .
INDIAN JOURNAL OF ORTHOPAEDICS, 2008, 42 (03) :323-329
[4]  
Cole JD, 2001, INJURY, V32, pD129
[5]  
GARCIACIMBRELO E, 1992, CLIN ORTHOP RELAT R, P116
[6]   Improved comfort in lower limb lengthening with the intramedullary skeletal kinetic distractor - Principles and preliminary clinical experiences [J].
Hankemeier, S ;
Pape, HC ;
Gosling, T ;
Hufner, T ;
Richter, M ;
Krettek, C .
ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, 2004, 124 (02) :129-133
[7]   THE TENSION STRESS EFFECT ON THE GENESIS AND GROWTH OF TISSUES .1. THE INFLUENCE OF STABILITY OF FIXATION AND SOFT-TISSUE PRESERVATION [J].
ILIZAROV, GA .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 1989, (238) :249-281
[8]  
ILIZAROV GA, 1989, CLIN ORTHOP RELAT R, P263
[9]   American academy of orthopaedic surgeons lower limb outcomes assessment instruments - Reliability, validity, and sensitivity to change [J].
Johanson, NA ;
Liang, MH ;
Daltroy, L ;
Rudicel, S ;
Richmond, J .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2004, 86A (05) :902-909
[10]   Leg lengthening using intramedullay skeletal kinetic distractor: Results of 57 consecutive applications [J].
Kenawey, Mohamed ;
Krettek, Christian ;
Liodakis, Emmanouil ;
Wiebking, Ulrich ;
Hankemeier, Stefan .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2011, 42 (02) :150-155