Effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YANG Huaqing , ZHANG Yaohua , HAN Qinghai , PENG Aimin , ZHENG Xuejian , QIN Sihe , XIA Hetao

Department of Orthopaedics, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, 100144, P.R.China;

Corresponding?author：

YANG Huaqing, Email: yhq402@126.com

Keywords：

Femoral lengthening; minimally invasive osteotomy; Ilizarov technique; intramedullary nail; external fixation

DOI：

10.7507/1002-1892.201804118

Video：

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ObjectiveTo explore the effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening.MethodsSeventy-one patients with femoral shortening deformity who met the selection criteria between January 2013 and June 2016 were randomly divided into trial group (36 cases were treated with minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening) and control group (35 cases were treated with simple Ilizarov technique for femoral lengthening). There was no significant difference in age, gender, causes of femoral shortening, length of femoral shortening, rate of femoral deformity between the two groups (P>0.05). The operation duration, intraoperative blood loss, lengthening rate, external fixation duration, frequency of pin tract infection, osteotomy healing time, and range of motion (ROM) of knee at 1 year after operation were recorded and compared between the two groups.ResultsThe patients of two groups were followed up 12-60 months (mean, 31 months). Pin tract infection occured in 8 cases (10 pins), including 1 case (1 pin) in the trial group and 7 cases (9 pins) in the control group. There was significant difference in the incidence of pin tract infection between the two groups (χ²=5.265, P=0.022). All patients were cured by replacing the fixation pins, changing dressing actively, application of antibiotics, and adequate postoperative care. The operation duration, intraoperative blood loss, external fixation duration, osteotomy healing time, and ROM of knee at 1 year after operation of the trial group were superior to those of the control group, showing significant differences (P<0.05). There was no significant difference in the lengthening rate between the two groups (t=–1.581, P=0.153).ConclusionThe minimally invasive osteotomy Ilizarov technique combined with intramedullary nail in femoral lengthening increases the operation time, but the external fixation duration and incidence of pin tract infection are significantly reduced and the function of knee is significantly improved.

Citation： YANG Huaqing, ZHANG Yaohua, HAN Qinghai, PENG Aimin, ZHENG Xuejian, QIN Sihe, XIA Hetao. Effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1524-1529. doi: 10.7507/1002-1892.201804118 Copy

1.	夏和桃. 實用骨外固定學. 北京: 人民衛生出版社, 2013: 878-886.
2.	黃雷, 朱峰, 王慎東, 等. 外固定架結合髓內釘延長術治療股骨缺損和不等長. 中華創傷骨科雜志, 2006, 8(7): 634-638.
3.	Launay F, Pesenti S. Bone lengthening: bridging joints, soft tissue releases, physiotherapy. J Children Orthop, 2016, 10(6): 517-519.
4.	Blum AL, BongioVanni JC, Morgan SJ, et al. Complications associated with distraction osteogenesis for infected nonunion of the femoral shaft in the presence of a bone defect: a retrospective series. J Bone Joint Surg (Br), 2010, 92(4): 565-570.
5.	Jabbar Y, Khaleel A. Experimental model for controlling shear using the Ilizarov frame. Clin Biomech, 2015, 30(9): 995-1001.
6.	焦紹鋒, 秦泗河, 王振軍, 等. Ilizarov技術結合組合性手術治療先天性腓側半肢畸形. 中國矯形外科雜志, 2017, 25(4): 312-316.
7.	高純志, 吳晗, 肖鵬, 等. Ilizarov技術結合有限手術治療青少年痙攣性馬蹄內翻足畸形. 中國修復重建外科雜志, 2018, 32(2): 182-186.
8.	Choi IH, Cho TJ, Moon HJ. Ilizarov treatment of congenital pseudarthrosis of the tibia; a multi-targeted approach using the Ilizarov technique. Clin Orthop Surg, 2011, 3(1): 1-8.
9.	Yoshino A, Takao M, Innami K, et al. Equinus deformity during tibial lengthening with ankle orthoses for equalization of leg-length discrepancies. J Orthop, 2011, 16(6): 756-759.
10.	樊靖, 張湘生, 劉儻, 等. 外固定器治療青少年伴有肢體短縮的膝外翻畸形. 中南大學學報(醫學版), 2013, 38(2): 191-195.
11.	宋德臣, 李瑞, 張有磊. 脛骨高位截骨術治療伴膝內翻的膝關節骨性關節炎. 中國矯形外科雜志, 2013, 21(9): 897-899.
12.	Al-Saati MF, Magnussen RA, Lustig S, et al. Distraction osteogenesis using a longitudinal corticotomy. Int Orthop, 2012, 36(5): 1073-1077.
13.	楊華清, 章耀華, 彭愛民, 等. Ilizarov技術微創脛骨高位截骨治療膝骨性關節炎伴膝內翻畸形. 中國醫師雜志, 2015, 17(1): 18-21.
14.	Rozbruch SR, Kleinman D, Fragomen AT, et al. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res, 2008, 466(12): 2923-2932.
15.	Kim H, Lee SK, Kim KJ. Lengthening using a reamed type intramedullary nail and an Ilizarov external fixator. Int Orthop, 2009, 33(3): 835-841.
16.	王斌, 賈松, 盧愛東, 等. 環式外固定器結合髓內釘行骨段滑移術治療脛骨非感染性骨缺損. 中國修復重建外科雜志, 2015, 29(11): 1348-1352.
17.	夏和桃. 肢體延長的基礎進展及臨床有關問題. 中國矯形外科雜志, 2007, 15(8): 605-612.
18.	Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg (Am), 2007, 89(1): 177-188.
19.	Burke NG, Cassar-Gheiti AJ, Tan J, et al. Regenerate bone fracture rate following femoral lengthening in paediatric patients. J Child Orthop, 2017, 11(3): 210-215.
20.	Andruszkow H, Dowrick AS, Frink M, et al. Surgical strategies in polytraumatized patients with femoral shaft fractures-Comparing a German and an Australian level Ⅰ trauma centre. Injury, 2013, 44(8): 1068-1072.

1. 夏和桃. 實用骨外固定學. 北京: 人民衛生出版社, 2013: 878-886.
2. 黃雷, 朱峰, 王慎東, 等. 外固定架結合髓內釘延長術治療股骨缺損和不等長. 中華創傷骨科雜志, 2006, 8(7): 634-638.
3. Launay F, Pesenti S. Bone lengthening: bridging joints, soft tissue releases, physiotherapy. J Children Orthop, 2016, 10(6): 517-519.
4. Blum AL, BongioVanni JC, Morgan SJ, et al. Complications associated with distraction osteogenesis for infected nonunion of the femoral shaft in the presence of a bone defect: a retrospective series. J Bone Joint Surg (Br), 2010, 92(4): 565-570.
5. Jabbar Y, Khaleel A. Experimental model for controlling shear using the Ilizarov frame. Clin Biomech, 2015, 30(9): 995-1001.
6. 焦紹鋒, 秦泗河, 王振軍, 等. Ilizarov技術結合組合性手術治療先天性腓側半肢畸形. 中國矯形外科雜志, 2017, 25(4): 312-316.
7. 高純志, 吳晗, 肖鵬, 等. Ilizarov技術結合有限手術治療青少年痙攣性馬蹄內翻足畸形. 中國修復重建外科雜志, 2018, 32(2): 182-186.
8. Choi IH, Cho TJ, Moon HJ. Ilizarov treatment of congenital pseudarthrosis of the tibia; a multi-targeted approach using the Ilizarov technique. Clin Orthop Surg, 2011, 3(1): 1-8.
9. Yoshino A, Takao M, Innami K, et al. Equinus deformity during tibial lengthening with ankle orthoses for equalization of leg-length discrepancies. J Orthop, 2011, 16(6): 756-759.
10. 樊靖, 張湘生, 劉儻, 等. 外固定器治療青少年伴有肢體短縮的膝外翻畸形. 中南大學學報(醫學版), 2013, 38(2): 191-195.
11. 宋德臣, 李瑞, 張有磊. 脛骨高位截骨術治療伴膝內翻的膝關節骨性關節炎. 中國矯形外科雜志, 2013, 21(9): 897-899.
12. Al-Saati MF, Magnussen RA, Lustig S, et al. Distraction osteogenesis using a longitudinal corticotomy. Int Orthop, 2012, 36(5): 1073-1077.
13. 楊華清, 章耀華, 彭愛民, 等. Ilizarov技術微創脛骨高位截骨治療膝骨性關節炎伴膝內翻畸形. 中國醫師雜志, 2015, 17(1): 18-21.
14. Rozbruch SR, Kleinman D, Fragomen AT, et al. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res, 2008, 466(12): 2923-2932.
15. Kim H, Lee SK, Kim KJ. Lengthening using a reamed type intramedullary nail and an Ilizarov external fixator. Int Orthop, 2009, 33(3): 835-841.
16. 王斌, 賈松, 盧愛東, 等. 環式外固定器結合髓內釘行骨段滑移術治療脛骨非感染性骨缺損. 中國修復重建外科雜志, 2015, 29(11): 1348-1352.
17. 夏和桃. 肢體延長的基礎進展及臨床有關問題. 中國矯形外科雜志, 2007, 15(8): 605-612.
18. Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg (Am), 2007, 89(1): 177-188.
19. Burke NG, Cassar-Gheiti AJ, Tan J, et al. Regenerate bone fracture rate following femoral lengthening in paediatric patients. J Child Orthop, 2017, 11(3): 210-215.
20. Andruszkow H, Dowrick AS, Frink M, et al. Surgical strategies in polytraumatized patients with femoral shaft fractures-Comparing a German and an Australian level Ⅰ trauma centre. Injury, 2013, 44(8): 1068-1072.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening

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