摘要:

We made a prospective survey of two basic bone lengthening techniques, percutaneous osteotomy and physeal distraction, in 61 patients with 142 bones treated and 93 lengthening processes in 3 years. The overall index of maturation was 1.16 months/cm. Male patients required less time for maturation of a given length than did females. The index of maturation varies according to the patient's etiology, 0.8 months/cm in patients undergoing symmetrical lengthening, whereas those with limb length discrepancy require 1.52 month/cm. The mean number of complications was slightly higher with physeal distraction than with percutaneous corticotomy. Patients with dysplastic etiology can achieve greater increases in length in shorter times than can nondysplastic patients. Patients with symmetrical hypometry had better results than patients with limb length discrepancy with regard not only to increase in length, but also to the time needed to achieve this length and the number of complications.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Bone lengthening processes are influenced by various biologic and mechanical parameters. In the Department of Orthopedics and Traumatology, University Clinic of Navarra, we performed several studies in lambs to try to explain some of these factors to obtain lengthened callus. Results explaining the effects of percutaneous osteotomy, the relation between medullary and periosteal vascularization, the importance of a delay phase after operation, the biology of physeal distraction, the effects of lengthening in soft tissues, and the mechanical conditions in experimental bone lengthening models are described.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This article states that callotasis is one of the methods most commonly used worldwide for limb lengthening. The procedure was devised and developed between 1975 and 1985 by Aldegheri, De Bastiani, and Renzi Brivio at Verona University, and consists of subperiosteal osteotomy in the proximal part of the diaphysis after application of an Orthofix unilateral fixator. After a 10-day period of neutral stabilization of the fragments, termed the waiting period, distraction is initiated, the rate and pace of which are adjusted in relation to the ossification capacity of the bone callus undergoing distraction. Biologic principles and surgical technique are discussed.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Case summaries and histological analyses of eight cases of limb lengthening by callus distraction are reported. Problems developing after lengthening required excision of some of the lengthened bone. Specimens were harvested and analyzed from 102 days to 4 years after lengthening. The earliest bone laid down was woven bone with high surface cellular activity. This soon became overlaid with lamellar bone, particularly at the cortex. Later Haversian architecture of cortical bone reappeared, and separate medullary bone developed, progressing toward the normal pattern, in contradistinction to the very abnormal bone that appears to be laid down subsequent to the Wagner method of lengthening. Of particular value in this study were the relatively large sizes of the specimens, allowing truly representative information on collagen orientation and bone surface architecture. The near-normal appearance of the new bone formed by callotasis gives confidence to surgeons about to embark on limb lengthening.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We wished to assess the true usefulness of ultrasound in limb lengthening by callotasis to ascertain if ultrasound can actually replace radiography at certain stages of the procedure. We examined radiograms and ultrasound scans of 100 segments (50 femurs, 50 tibias) at different stages during the lengthening procedure. Ultrasound proved effective in replacing radiography during the period of distraction to assess ossification of the newly formed bone. Ultrasound moreover gives more— and more detailed—information than radiography in the study of possible problems associated with the soft tissue-cortex-screw interface.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

One hundred lower limb lengthenings were performed in 98 patients by the Anderson (25 tibias, group A), Wagner (45 femurs, group B), and Ilizarov (16 femurs and 14 tibias, group C) methods in the Department of Orthopaedic and Traumatologic Surgery of the University of São Paulo School of Medicine from 1971 to 1991. Results obtained with the three methods, problems and complications observed, and comparison of healing time between the methods of lengthening used are reported. In group A, lengthening ranged from 3 to 6 cm (average 4.2 cm); healing time ranged from 121 to 331 days (average 196.88 days), with an average lengthening index of 1.72 months/cm. In group B, femoral lengthening ranged from 1 to 12.5 cm (average 4.6 cm); average healing time for group Bl (percutaneous osteotomy) was 185.4 days, and lengthening index was 1.32 months/cm; healing time for group B2 (corticotomy) was 156.3 days, with lengthening index of 1.23 months/cm. In group C, femoral lengthening ranged from 1.0 to 7.5 cm (average 4.7 cm), and healing time ranged from 58 to 441 days (mean of 185.6 days); the lengthening index was 1.31 months/cm. For Ilizarov tibial lengthening, lengthening ranged from 1.0 to 7.5 cm (average 4.5 cm), healing time ranged from 94 to 386 days (mean of 184 days), lengthening index was 1.35 months/cm. With the Anderson method, the most common complication was delayed union; with the Wagner technique, the most common complications were related to bone healing (fracture, implant failure after the second stage, nonunion); and with the Ilizarov method, the most common complication was incomplete corticotomy. Overall results were good despite the complications, and we emphasize the necessity for the surgeon to understand the principles of leg lengthening to achieve good results.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Results of different lengthening procedures in 51 patients with unilateral congenital short femur are reported. Emphasis is placed on stability of the hip joint, which is a prerequisite for any femoral lengthening procedure. Combination of lengthening procedures of the femur and tibia with shortening techniques can correct discrepancies ≤30 cm. For complicated cases, the ring fixator, offering stability of hip and knee joints, is preferred to unilateral devices. Femoral lengthening in femoral focal deficiency should always be performed distally.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Twenty-six bifocal lengthenings in 18 patients were reviewed in an attempt to identify the major indications, including extreme shortening, shortening with deformity and shortening with joint stiffness, soft tissue scarring, or obesity. A management classification is described and almost all cases considered would fit into the “high-risk linear” or “high-risk complex” groups. Despite the complexity of the cases, the theoretical advantages of this technique such as reduced soft tissue tension, and increased fixator stability leading to faster and more reliable consolidation, appear to be borne out in practice. In nonpathological states bone healing indexes of 21.5 days/cm for tibias and 22.4 days/cm for femurs were recorded. A major problem is knee stiffness during femoral lengthening resulting from the proximity of the distal screws to the joint with transfixation of the fascia lata and vastus lateralis. Bifocal lengthening may well become a standard technique for lengthenings >6 cm.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We report a series of 47 upper metaphyseal lengthenings of the tibia by callotasis in 40 children and adolescents. Fifteen cases were treated with a Judet T distractor; the remaining 32 were treated with a device designed by the authors (Orthofix) which permits axial correction in the frontal plane for better control of the valgus deviation. Results are compared with those of other studies, with particular reference to series of lengthenings by the Ilizanov method. Complications occurred in 29 of the 47 lengthenings. Of these, 11 were benign, 17 required treatment not included in the original protocol, and one gave rise to sequelae. Consolidation was rapid, with only one fracture and one nonunion. We stress the excellent control of valgus obtained with this lengthener, obviating the need for tibial realignment by further operation. We emphasize the importance of appropriate dynamization of the callus, with controlled micromovements provided by a silastic collar (Dyna-Ring) resulting in an average decrease in healing time of 28%. The technique for its use is explained in detail.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We describe our experience in treatment of lower limb dyssymmetries in patients who had undergone treatment for a primitive malignant bone tumor. Eight cases are reported, six male and two female patients whose ages ranged from 12 to 16 years. The dyssymmetry varied from 7 to 18 cm. In seven patients, lengthening and consolidation has already been completed; the lengthening process is still in progress in the eighth patient. The dyssymmetry was fully corrected in five patients; residual dyssymmetry of 3 and 4 cm remained in the other two. We believe that this type of operation could be useful in patients with severe dyssymmetry as a consequence of malignant bone tumors.

ISSN:0271-6798    

出版商:OVID    

年代:1993

数据来源: OVID