Kritické zpracování prodlužování femuru za posledních deset let

KAISER ŠRÁMKOVÁ, Ludmila, Jan POUL, J. STRAKA, Karel URBÁŠEK, Tomáš PAVLÍK and Michaela CVANOVÁ. Kritické zpracování prodlužování femuru za posledních deset let (Femoral Lengthening. A Critical Review of Ten-Year Results). Acta Chirurgiae Orthopaedicae et Traumatologiae Čechoslovaca. 2011, vol. 78, No 3, p. 244-248. ISSN 0001-5415.

Basic information

Original name

Kritické zpracování prodlužování femuru za posledních deset let

Name (in English)

Femoral Lengthening. A Critical Review of Ten-Year Results

Authors

KAISER ŠRÁMKOVÁ, Ludmila (203 Czech Republic, guarantor, belonging to the institution), Jan POUL (203 Czech Republic), J. STRAKA (203 Czech Republic), Karel URBÁŠEK (203 Czech Republic, belonging to the institution), Tomáš PAVLÍK (203 Czech Republic, belonging to the institution) and Michaela CVANOVÁ (203 Czech Republic, belonging to the institution)

Edition

Acta Chirurgiae Orthopaedicae et Traumatologiae Čechoslovaca, 2011, 0001-5415

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Other information

Language

Czech

Type of outcome

Článek v odborném periodiku

Field of Study

30200 3.2 Clinical medicine

Country of publisher

Czech Republic

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 1.628 in 2009

RIV identification code

RIV/00216224:14110/11:00053915

Organization unit

Faculty of Medicine

UT WoS

000292533100009

Keywords in English

femoral lengthening; external fixator; complications

Tags

International impact

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Abstract

V originále

Prodlužování femuru je v poslední době realizováno buď intramedulárními prodlužovacími hřeby (14, 19) nebo klasicky zevními fixátory ať již cirkulárními fixá-tory dle Ilizarova (2,7,12) nebo monolaterálními zevními fixátory (7, 14, 22). Naše pracoviště (KDCHOT FN Brno) používalo v posledních deseti letech rutinně pouze monolaterální zevní fixátory (typ Mefisto, Orthofix, Prospon). Prodlužování femuru je velmi často spojeno s řadou problémů, překážek a komplikací (1,4, 8,9,10, 19, 22). Cílem této studie bylo kriticky a nezávisle vyhodnotit průběh prodlužování a komplikace nezávislým pozorovatelem, mladším lékařem pracujícím na jiném pracovišti. Zpracování bylo založeno na studiu zdravotnické dokumentace, rtg snímků a pravidelných kontrol.

In English

A total of 28 femoral lengthening procedures were carried out in 26 patients,16 girls and 10 boys. The external fixator Mephisto was used in 24 cases; fixators Prospon and Orthofix in one and three cases, respectively. Fifteen patients were treated for congenital short femur, the rest had secondary femoral shortening due to following pathologies: distal femoral epiphysiolysis in five children, proximal femoral osteomyelitis in one child, avascular necrosis of the femoral head in one, diaphyseal femur fracture in one, enchondromatosis of the distal femur with growth plate destruction in one, and contralateral femur overgrowth following a fracture in one child. The average age at the beginning of treatment was 11 (range, 4-16) years. Complications were classified as mild, serious and critical. The results were statistically analysed using several statistical tests. The average parameter values for the group included: total femoral lengthening, 40.2.mm (SD +/- 11.1); osteotomy index (OI), 41 % (SD +/- 9.8); lengthening percentage (LP), 10.9 % (SD +/- 3.8); lengthening index (LI), 14.5 (SD +/- 3.5) days/cm; healing index (HI), 52.6 (SD +/- 20.1) days/cm; and consolidation index (CI), 93.3 (SD +/- 40.0) days/cm. Mild complications were recorded in 11, and serious and critical in eight patients. Fourteen patients were free of any complications. Two complications were concurrently found in five patients. There was a statistically significant difference in the LP values related to the number of complications (p=0.019). No significant relationship was recorded on comparison of the HI value with the patient's age at the time of surgery (p=0.836) and patient's gender (p=0.546) (Mann-Whitney test). The relationship of the OI value to the HI value was non-significant (p=0.492), as was the relationship between the osteotomy technique (oscillating or Gigli saw osteotomy) and the occurrence of complications (p=1.000) (Fisher's exact test). Correlation between the LI and HI values was significant (p<0.001). The results of healing after lengthening, as assessed by the healing and the consolidation index, were in agreement with other authors' data. The lower number of complications, particularly fractures of bone regenerate, can be explained by the facts that, in our study, the lengthening percentage was lower and that the post-operative care was strictly observed, including dynamic axial loading which stimulates bone consolidation at the lengthened section, with adherence to the proof of three developed cortices. Our results did not confirm the assumption that slower lengthening will have a favourable effect on the healing index.