严重腓骨半脱位患者的肢体延长和畸形矫正:贝尔格莱德儿童大学医院的经验

Q3 Medicine Genij Ortopedii Pub Date : 2024-02-20 DOI:10.18019/1028-4427-2024-30-1-38-45
M. Lazović, S. Leonchuk, S. Ducić, Sh. A. Imomov, D. A. Popkov
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The long-term result of treatment was evaluated at least 1 year after the end of tibial lengthening. Evaluation criteria after tibia lengthening were external osteosynthesis index, amount of lengthening, assessment of outcomes according to Lascombes. Walking ability was assessed using Gillette questionnaire.Results The approach we used gave excellent and good results in 83 % of cases after the first reconstructive stage. Complications and recurrences of deformities encountered during the first stage were eliminated during subsequent planned limb lengthening. The average magnitude of lengthening was 6.4 ± 2.4 cm (37.2 ± 12.4 % of the initial segment length). The index of external osteosynthesis was 22.9 ± 12.2 days/cm. Monofocal distraction osteosynthesis was used in 9 cases and bifocal osteosynthesis in three cases. 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引用次数: 0

摘要

背景腓骨半脱位(FH)是一种先天性疾病,表现为膝关节外翻畸形和不稳定、胫骨缩短和畸形、足和踝关节发育不良和畸形。本文旨在确定在矫正胫骨畸形的同时对足部进行单独重建,然后根据 Paley 标准对 3 型和 4 型 FH 患者进行胫骨延长术的疗效。这些患者的年龄都不超过 24 个月,他们在接受足部重建治疗的同时,还接受了胫骨畸形矫正术,随后又接受了单独阶段的胫骨延长术。胫骨延长术在患者 4.6 ± 1.2 岁时进行。胫骨延长术结束至少一年后,对治疗的长期效果进行评估。胫骨延长术后的评估标准是外骨合指数、延长量、Lascombes评估结果。我们采用的方法在第一重建阶段后,83%的病例取得了极佳和良好的效果。在第一阶段中出现的并发症和畸形复发在随后的计划肢体延长中得以消除。平均延长幅度为 6.4 ± 2.4 厘米(初始肢体长度的 37.2 ± 12.4%)。外部骨合成指数为 22.9 ± 12.2 天/厘米。9例采用了单焦点牵张骨合成术,3例采用了双焦点骨合成术。根据Lascombes的分类,7例患者的延长结果为IA,4例为IB,1例为2B。在重度 FH 患儿中,重建骨科手术和胫骨延长术的分期有两种观点。结论重度 FH 患儿在早期(16-24 个月)重建足踝关节,然后(4-6 岁)延长小腿的策略被证明是有效的,如果患者父母选择了这一策略,就可以使用。对于 3C 型病例,在第一阶段使用外固定矫正畸形并同时延长胫骨是另一种合理的策略选择。
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Limb lengthening and deformity correction in patients with severe fibular hemimelia: experience of the children's university hospital in Belgrade
Background Fibular hemimelia (FH) is a congenital disease manifested by valgus deformity and instability of the knee joint, shortening and deformity of the tibia, hypoplasia and deformities of the foot and ankle.The aim of this paper was to determine the efficacy of the strategy of separate reconstruction of the foot along with correction of tibia deformity, and then tibial lengthening in patients with FH of types 3 and 4 according to Paley.Methods This retrospective study is based on an analysis of the treatment of 12 children with severe FH. The patients, aged no older than 24 months, were treated for foot reconstruction along with correction of tibial deformity followed by a separate stage of tibial lengthening. Tibial lengthening was performed in the age 4.6 ± 1.2 years. The long-term result of treatment was evaluated at least 1 year after the end of tibial lengthening. Evaluation criteria after tibia lengthening were external osteosynthesis index, amount of lengthening, assessment of outcomes according to Lascombes. Walking ability was assessed using Gillette questionnaire.Results The approach we used gave excellent and good results in 83 % of cases after the first reconstructive stage. Complications and recurrences of deformities encountered during the first stage were eliminated during subsequent planned limb lengthening. The average magnitude of lengthening was 6.4 ± 2.4 cm (37.2 ± 12.4 % of the initial segment length). The index of external osteosynthesis was 22.9 ± 12.2 days/cm. Monofocal distraction osteosynthesis was used in 9 cases and bifocal osteosynthesis in three cases. The results of lengthening were classified by Lascombes as IA in 7 cases, IB in four cases, 2B in one case.Discussion In severe FH, the question of reconstruction or early amputation remains open. There are two opinions on the staging of reconstructive orthopedic surgery and tibial lengthening in young children with severe FH.Conclusion The strategy of reconstruction of the foot and ankle joint at an early age (16-24 months) in children with severe FH followed by lengthening of the lower leg (at the age of 4-6 years) proved to be effective and can be used when it is chosen by the patient's parents. In 3C type cases, the use of external fixation to correct the deformity and simultaneously lengthen the tibia at the first stage is an alternative reasonable strategy option.
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来源期刊
Genij Ortopedii
Genij Ortopedii Medicine-Surgery
CiteScore
0.70
自引率
0.00%
发文量
104
审稿时长
12 weeks
期刊介绍: Journal’s main goal is to contribute to the development of the contemporary medical science via presentation of fundamental and applied original scientific studies to the scientific and practical medical community that would widen and deepen the understanding of the most important problems in the field of traumatology, orthopaedics, and related specialties. Our journal provides a direct open access to its content which is based on the principle that the open access option promotes global exchange of knowledge and experience. Journal’s strategy: -Development of the journal as a scientific platform for researchers, doctors, post-graduates and residents -Attraction of highly-cited authors to publish their studies -Selection of manuscripts of scientific interest for readers that will impact on journal citation index in RINC -Increase in the portion of publications submitted by foreign authors and studies conducted in association with foreign scientists; growth of citations in the journals that are included into global systems of indexing and reputable databases -Improvement of the Journal’s web site in two languages for a greater accessibility by authors and readers -Introduction of the Journal into global indexing systems
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