Alt ekstremite uzatılmasında intramedüller kinetik distraktör kullanımı

Year 2014, Volume: 48 Issue: 3, 307 - 312, 30.05.2014

Ozgur Karakoyun Metin Kucukkaya Sami Sokucu

https://doi.org/10.3944/AOTT.2014.13.0048

Abstract

Amaç:Bu çalışmada intramedüller kinetik distraktör (ISKD) çivisi ile ekstremite uzatması yaptığımız hastaların klinik ve radyolojik sonuçlarını değerlendirmeyi amaçladık.

Çalışma planı: Bu çalışmada 12 hastanın [7 erkek, 5 kadın; ortalama yaş: 27 (13-40)], 10 femur ve 2 tibiasına ISKD ile uzatma ameliyatı yapıldı. Hastaların ortalama ekstremite kısalığı 4.41 cm (2–7) olarak saptandı. Ameliyattan 7 gün sonra hastalara uzatma egzersizleri öğretilerek ekstremite uzatmasına başlandı. Uzatmanın distraksiyon döneminde haftalık olarak ve konsolidasyon döneminde ise 2 haftada bir grafi kontrolü yapıldı. Bir tibia uzatma vakası uzatması tamamlandıktan sonra takipten çıktı.

Bulgular: Tüm hastalarda hedeflenen uzama sağlandı. Ortalama uzama 4.41 cm (2-7) idi. Ortalama kemik iyileşme indeksi 37.8 gün/cm (28.5-78.0) idi. Olgulardan 4 tanesinde kontrolsüz distraksiyon oldu. Bu olgulardan birinde kemik rejeneratının kötü oluşması nedeniyle greftleme yapıldı. Çivinin kilitlenip uzamanın durduğu bir olguda anestezi altında kapalı manipulasyon ile uzama sağlandı. Hiçbir hastada eklem sertliği görülmedi.

Çıkarımlar: İntramedüller uzayabilen çiviler, eklem kontraktürü ve enfeksiyon riskini düşürmektedir. Hastalar tarafından daha iyi tolere edilen bu implantlar hastaların günlük aktivitelerine daha erken dönmesine yardımcı olmaktadır.

Keywords

Kinetik distraksiyon; ekstremite uzatma; uzayabilen intramedüller çivi; deformite

Intramedullary skeletal kinetic distractor in lower extremity lengthening

Abstract

Objective:The aim of this study was to report the clinical and radiological results of patients with Intramedullary Skeletal Kinetic Distractor (ISKD) lengthening.

Methods: Ten femoral and 2 tibial lengthening were performed in 12 patients (7 male, 5 female; mean age: 27 years (13-40)) by using ISKD nail. The mean limb length discrepancy of the patients was 4.41 cm (2-7). On the postoperative 7th day the patients were trained about lengthening and the lengthening started. Follow-up X rays were taken weekly during the distraction period and every second weeks during the consolidation period. One patient with tibia lengthening was lost to follow-up after completing the distraction period.

Results: The planned lengthening amounts were achieved in all of the cases. The mean lengthening was 4.41 cm (2-7). The mean bone healing index was 37.8 day/cm (28.5-78.0). There were uncontrolled distractions in 4 cases. Autogenous bone grafting was necessary in a case with incompetent bone formation. The kinetic nail was locked and failed to distract in a patient, in which the problem was solved with closed manipulation under anesthesia. No patient had a joint stiffness.

Conclusion: Intramedullary extensible nails decrease the risk of joint contractures and infection. This procedure can be well tolerated by the patients and they can return to their daily activities earlier.

Keywords

Kinetic distraction, limb lengthening, extensible intramedullary nail, deformity

References

• Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clin Orthop Relat Res 1994;301:10-8.
• Harbacheuski R, Fragomen AT, Rozbruch SR. Does lengthening and then plating (LAP) shorten duration of external fixation? Clin Orthop Relat Res 2012;470:1771 CrossRef
• Iobst CA, Dahl MT. Limb lengthening with submuscular plate stabilization: a case series and description of the technique. J Pediatr Orthop 2007;27:504-9. CrossRef
• Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990;250:81-104.
• Kocaoglu M, Eralp L, Kilicoglu O, Burc H, Cakmak M. Complications encountered during lengthening over an intramedullary nail. J Bone Joint Surg Am 2004;86A:2406-11.
• Cole JD, Justin D, Kasparis T, DeVlught D, Knobloch C. The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia. Injury 2001;32 Suppl 4:SD129-39. CrossRef
• Krieg AH, Lenze U, Speth BM, Hasler CC. Intramedullary leg lengthening with a motorized nail. Acta Orthop 2011;82:344-50. CrossRef
• Dinçyürek H, Kocaoğlu M, Eralp IL, Bilen FE, Dikmen G, Eren I. Functional results of lower extremity lengthening by motorized intramedullary nails. Acta Orthop Traumatol Turc 2012;46:42-9. CrossRef
• Simpson AH, Shalaby H, Keenan G. Femoral lengthening with the Intramedullary Skeletal Kinetic Distractor. J Bone Joint Surg Br 2009;91:955-61. CrossRef
• Kucukkaya M, Karakoyun O, Kuzgun U. Lengthening over a retrograde nail using 3 Schanz pins. J Orthop Trauma 2013;27:e13-7.
• Kenawey M, Krettek C, Liodakis E, Wiebking U, Hankemeier S. Leg lengthening using intramedullay skeletal kinetic distractor: results of 57 consecutive applications. Injury 2011;42:150-5. CrossRef
• Guichet JM, Casar RS. Mechanical characterization of a totally intramedullary gradual elongation nail. Clin Orthop Relat Res 1997;337:281-90. CrossRef
• Rozbruch SR, Kleinman D, Fragomen AT, Ilizarov S. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res 2008;466:2923-32. CrossRef
• Wang K, Edwards E. Intramedullary skeletal kinetic distractor in the treatment of leg length discrepancy-a review of 16 cases and analysis of complications. J Orthop Trauma 2012;26:e138-44. CrossRef
• Mahboubian S, Seah M, Fragomen AT, Rozbruch SR. Femoral lengthening with lengthening over a nail has fewer complications than intramedullary skeletal kinetic distraction. Clin Orthop Relat Res 2012;470:1221-31.
• Kenawey M, Krettek C, Liodakis E, Meller R, Hankemeier S. Insufficient bone regenerate after intramedullary femoral lengthening: risk factors and classification system. Clin Orthop Relat Res 2011;469:264-73. CrossRef
• Al-Sayyad MJ. Lower limb lengthening and deformity correction using the Fitbone motorized nail system in the adolescent patient. J Pediatr Orthop B 2012;21:131-6.
• Baumgart R, Hinterwimmer S, Krammer M, Hierl T, Mutschler W. A fully implantable, programmable distraction nail (Fitbone) - new perspectives for corrective and reconstructive limb survey. In: Leung KS, Taglang G, Schnettler R, editors. Practice of intramedullary locked nails. New developments in techniques and application. Heidelberg: Springer; 2006. p. 189-90. CrossRef