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. 实用骨外固定学. 北京: 人民卫生出版社, 2013: 878-886.
2.	黄雷, 朱峰, 王慎东, 等. 外固定架结合髓内钉延长术治疗股骨缺损和不等长. 中华创伤骨科杂志, 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.	焦绍锋, 秦泗河, 王振军, 等. Ilizarov技术结合组合性手术治疗先天性腓侧半肢畸形. 中国矫形外科杂志, 2017, 25(4): 312-316.
7.	高纯志, 吴晗, 肖鹏, 等. Ilizarov技术结合有限手术治疗青少年痉挛性马蹄内翻足畸形. 中国修复重建外科杂志, 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, 张湘生, 刘傥, 等. 外固定器治疗青少年伴有肢体短缩的膝外翻畸形. 中南大学学报(医学版), 2013, 38(2): 191-195.
11.	宋德臣, 李瑞, 张有磊. 胫骨高位截骨术治疗伴膝内翻的膝关节骨性关节炎. 中国矫形外科杂志, 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.	杨华清, 章耀华, 彭爱民, 等. Ilizarov技术微创胫骨高位截骨治疗膝骨性关节炎伴膝内翻畸形. 中国医师杂志, 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, 贾松, 卢爱东, 等. 环式外固定器结合髓内钉行骨段滑移术治疗胫骨非感染性骨缺损. 中国修复重建外科杂志, 2015, 29(11): 1348-1352.
17.	夏和桃. 肢体延长的基础进展及临床有关问题. 中国矫形外科杂志, 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. 实用骨外固定学. 北京: 人民卫生出版社, 2013: 878-886.
2. 黄雷, 朱峰, 王慎东, 等. 外固定架结合髓内钉延长术治疗股骨缺损和不等长. 中华创伤骨科杂志, 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. 焦绍锋, 秦泗河, 王振军, 等. Ilizarov技术结合组合性手术治疗先天性腓侧半肢畸形. 中国矫形外科杂志, 2017, 25(4): 312-316.
7. 高纯志, 吴晗, 肖鹏, 等. Ilizarov技术结合有限手术治疗青少年痉挛性马蹄内翻足畸形. 中国修复重建外科杂志, 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, 张湘生, 刘傥, 等. 外固定器治疗青少年伴有肢体短缩的膝外翻畸形. 中南大学学报(医学版), 2013, 38(2): 191-195.
11. 宋德臣, 李瑞, 张有磊. 胫骨高位截骨术治疗伴膝内翻的膝关节骨性关节炎. 中国矫形外科杂志, 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. 杨华清, 章耀华, 彭爱民, 等. Ilizarov技术微创胫骨高位截骨治疗膝骨性关节炎伴膝内翻畸形. 中国医师杂志, 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, 贾松, 卢爱东, 等. 环式外固定器结合髓内钉行骨段滑移术治疗胫骨非感染性骨缺损. 中国修复重建外科杂志, 2015, 29(11): 1348-1352.
17. 夏和桃. 肢体延长的基础进展及临床有关问题. 中国矫形外科杂志, 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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