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Uzatma öncesi yapılan akut düzeltmenin distraksiyon osteogenezi üzerinde olumsuz bir etkisi var mıdır

Year 2015, , 405 - 409, 19.08.2015
https://doi.org/10.3944/AOTT.2015.14.0275

Abstract

Özet

Amaç

Akut düzeltme sonrası uzatmanın distraksiyon osteogenezi sırasındaki kemik iyileşmesi üzerinde olumsuz bir etkisi olup olmadığı halen tartışmalıdır. Bu çalışmamızda uzatma öncesi yapılan akut deformite düzeltmenin kemik iyileşmesi üzerinde olumsuz bir etkisi olup olmadığını araştırdık.

Çalışma planı

Femurda kısalığı olan hastalardan oluşan 3 grup oluşturduk. Tüm olgularda distal metafizer osteotomi sonrası retrograd intramedüller çivileme uyguladık. Birinci grup (9 femur) akut korreksiyon sonrası uzatma çivileri ile 4 cm ve 4 cm’den fazla uzatma yaptığımız olguları içeriyordu. 2. grup (16 femur) uzatma çivileri ile sadece 4 cm ve daha fazla uzatma yaptığımız olgulardan oluşturuldu. 3 grupta (13 femur)  ise akut düzeltme sonrası retrograd çivi üzerinden uzatma (RÇÜU) tekniğini uyguladığımız hastalar bulunuyordu.     

Sonuçlar

Hastaların iyileşme indeksleri ve tam yük verme zamanları değerlendirildi. Ortalama uzatma miktarları gruplarda sırası ile 6.6 cm (4–14 cm), 5.7 cm (4–8 cm), 5.2 cm (4–6.5 cm) olarak hesaplandı. Ortalama radyolojik konsolidasyon indeksleri ve tam yük verme zamanları sırası ile 31.0±8.2, 30.2±5.5, and 39.0 ± 5.0 gün/cm olarak gerçekleşti. 1. ve 2. Gruplarda konsolidasyon indeksleri 3. grupla karşılaştırıldığında anlamlı derecede daha iyiydi. İlk iki grup arasında ise bu açıdan bir farklılık yoktu.

Çıkarımlar

Akut düzeltmenin yeni nesil intramedüller uzatma çivileri kullanılarak yapılan distraksiyon osteogenezi sonrasında kemik iyileşmesi üzerinde olumsuz bir etkisi yoktur. RÇÜU tekniği kullanılan hastalarda iyileşmenin uzun sürmesinin ve konsolidasyon indeksinin uzun olmasının nedeninin fiksatör pinlerinin periost kan akımını bozması olduğu çıkarımında bulunabiliriz.

 

DOI: 10.3944/AOTT.2015.14.0275

Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

References

  • Thaller PH, Fürmetz J, Wolf F, Eilers T, Mutschler W. Limb lengthening with fully implantable magnetically actuated mechanical nails (PHENIX(®))-preliminary re- sults. Injury 2014;45 Suppl 1:60–5.
  • Krieg AH, Speth BM, Foster BK. Leg lengthening with a motorized nail in adolescents : an alternative to external fixators? Clin Orthop Relat Res 2008;466:189–97.
  • Al-Sayyad MJ. Lower limb lengthening and deformity cor- rection using the Fitbone motorized nail system in the ado- lescent patient. J Pediatr Orthop B 2012;21:131–6.
  • Ilizarov GA. The transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tis- sue. Berlin: Springer-Verlag; 1992.
  • Noonan KJ, Price CT, Sproul JT, Bright RW. Acute cor- rection and distraction osteogenesis for the malaligned and shortened lower extremity. J Pediatr Orthop 1998;18:178– 86.
  • Donnan LT, Saleh M, Rigby AS. Acute correction of low- er limb deformity and simultaneous lengthening with a monolateral fixator. J Bone Joint Surg Br 2003;85:254–60.
  • Kucukkaya M, Karakoyun O, Kuzgun U. Lengthening over a retrograde nail using 3 Schanz pins. J Orthop Trau- ma 2013;27:13–7.
  • Kamegaya M, Shinohara Y, Shinada Y. Limb lengthen- ing and correction of angulation deformity: immediate correction by using a unilateral fixator. J Pediatr Orthop 1996;16:477–9.
  • Dinçyürek H, Kocaoğlu M, Eralp IL, Bilen FE, Dikmen G, Eren I. Functional results of lower extremity lengthening by motorized intramedullary nails. Acta Orthop Trauma- tol Turc 2012;46:42–9.

Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis?

Year 2015, , 405 - 409, 19.08.2015
https://doi.org/10.3944/AOTT.2015.14.0275

Abstract

Objective: Lengthening after acute correction has a negative effect on bone healing during distraction osteogenesis. In this study, we investigated whether correcting an acute deformity prior to lengthening resulted in a negative effect on bone healing.
Methods: Patients with shortened femora were assigned to 3 matched groups. Retrograde femoral nailing after distal metaphyseal-diaphyseal osteotomy was used in all cases. Group 1 (9 femora) included cases of lengthening >4 cm using intramedullary distraction devices after acute correction. Group 2 (16 femora) included pure lengthening cases of ≥4 cm using intramedullary distraction devices. Group 3 (13 femora) included cases of lengthening ≥4 cm with lengthening and the retrograde nailing method (LORN) following acute correction.
Results: Healing indices and full weight-bearing times of patients were evaluated. Mean lengthening values were 6.6 (range: 4–14 cm), 5.7 (range: 4–8 cm), and 5.2 cm (range: 4–6.5 cm) in Groups 1–3, respectively, and mean radiographic consolidation index and full weight-bearing times were 31.0±8.2, 30.2±5.5, and 39.0±5.0 day/cm in Groups 1–3, respectively. The consolidation index was significantly better in the Groups 1 and 2 compared to that in Group 3, but no difference was detected between Groups 1 and 2.
Conclusion: Acute correction had no negative effect on bone healing after distraction osteogenesis using new-generation intramedullary distraction devices. We suggest that the negative impact on healing and the prolonged consolidation index in patients undergoing LORN may be due to impaired periosteal blood supply due to fixator pins.

References

  • Thaller PH, Fürmetz J, Wolf F, Eilers T, Mutschler W. Limb lengthening with fully implantable magnetically actuated mechanical nails (PHENIX(®))-preliminary re- sults. Injury 2014;45 Suppl 1:60–5.
  • Krieg AH, Speth BM, Foster BK. Leg lengthening with a motorized nail in adolescents : an alternative to external fixators? Clin Orthop Relat Res 2008;466:189–97.
  • Al-Sayyad MJ. Lower limb lengthening and deformity cor- rection using the Fitbone motorized nail system in the ado- lescent patient. J Pediatr Orthop B 2012;21:131–6.
  • Ilizarov GA. The transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tis- sue. Berlin: Springer-Verlag; 1992.
  • Noonan KJ, Price CT, Sproul JT, Bright RW. Acute cor- rection and distraction osteogenesis for the malaligned and shortened lower extremity. J Pediatr Orthop 1998;18:178– 86.
  • Donnan LT, Saleh M, Rigby AS. Acute correction of low- er limb deformity and simultaneous lengthening with a monolateral fixator. J Bone Joint Surg Br 2003;85:254–60.
  • Kucukkaya M, Karakoyun O, Kuzgun U. Lengthening over a retrograde nail using 3 Schanz pins. J Orthop Trau- ma 2013;27:13–7.
  • Kamegaya M, Shinohara Y, Shinada Y. Limb lengthen- ing and correction of angulation deformity: immediate correction by using a unilateral fixator. J Pediatr Orthop 1996;16:477–9.
  • Dinçyürek H, Kocaoğlu M, Eralp IL, Bilen FE, Dikmen G, Eren I. Functional results of lower extremity lengthening by motorized intramedullary nails. Acta Orthop Trauma- tol Turc 2012;46:42–9.
There are 9 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Ozgur Karakoyun This is me

Metin Kucukkaya This is me

Mehmet Erol This is me

Publication Date August 19, 2015
Published in Issue Year 2015

Cite

APA Karakoyun, O., Kucukkaya, M., & Erol, M. (2015). Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis?. Acta Orthopaedica Et Traumatologica Turcica, 49(4), 405-409. https://doi.org/10.3944/AOTT.2015.14.0275
AMA Karakoyun O, Kucukkaya M, Erol M. Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis?. Acta Orthopaedica et Traumatologica Turcica. August 2015;49(4):405-409. doi:10.3944/AOTT.2015.14.0275
Chicago Karakoyun, Ozgur, Metin Kucukkaya, and Mehmet Erol. “Does Lengthening After Acute Correction Negatively Affect Bone Healing During Distraction Osteogenesis?”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 4 (August 2015): 405-9. https://doi.org/10.3944/AOTT.2015.14.0275.
EndNote Karakoyun O, Kucukkaya M, Erol M (August 1, 2015) Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis?. Acta Orthopaedica et Traumatologica Turcica 49 4 405–409.
IEEE O. Karakoyun, M. Kucukkaya, and M. Erol, “Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis?”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 4, pp. 405–409, 2015, doi: 10.3944/AOTT.2015.14.0275.
ISNAD Karakoyun, Ozgur et al. “Does Lengthening After Acute Correction Negatively Affect Bone Healing During Distraction Osteogenesis?”. Acta Orthopaedica et Traumatologica Turcica 49/4 (August 2015), 405-409. https://doi.org/10.3944/AOTT.2015.14.0275.
JAMA Karakoyun O, Kucukkaya M, Erol M. Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis?. Acta Orthopaedica et Traumatologica Turcica. 2015;49:405–409.
MLA Karakoyun, Ozgur et al. “Does Lengthening After Acute Correction Negatively Affect Bone Healing During Distraction Osteogenesis?”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 4, 2015, pp. 405-9, doi:10.3944/AOTT.2015.14.0275.
Vancouver Karakoyun O, Kucukkaya M, Erol M. Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis?. Acta Orthopaedica et Traumatologica Turcica. 2015;49(4):405-9.