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Akondroplastik hastalarda femur ve tibianın bilateral ve eş zamanlı uzatılması

Yıl 2014, Cilt: 48 Sayı: 2, 157 - 163, 18.04.2014
https://doi.org/10.3944/AOTT.2014.3274

Öz

Amaç: Bu çalışmada akondroplastik hastaların femur ve tibialarının bilateral ve eş zamanlı olarak uzatılmasının doğuracağı sonuçlar ve komplikasyonlar analiz edildi.

Çalışma planı: Çalışmaya 44 femur ve 44 tibiasında eş zamanlı uzatma yapılan 22 akondroplastik hasta (16 kız, 6 erkek; ortalama yaş: 6.36, dağılım: 3-11) alındı. Femurların uzatılması için Orthofix LRS monolateral fiksatörler kullanılırken, tibiaların uzatılmasında Ilizarov tipi veya hexapod tipi sirküler eksternal fiksatörlerden yararlanıldı. Kalça fleksörleri ve Aşil tendonunda gerçekleştirilen tenotomilerle, büyüme plaklarının hasar görmesinin ve eklem kontraktürlerinin önüne geçildi. Sonuçlar ve komplikasyonlar Paley sınıflaması ve komplikasyon sistemlerine göre değerlendirildi.

Bulgular: Hastaların ortalama takip süresi 35 (dağılım: 26-76) ay idi. Femurlar ortalama 7.07 cm (%46.1) uzatılırken, tibialardaki ortalama uzama 6.64 cm (%52.9) olarak ölçüldü. Hastaların boyu, fizyolojik büyümeleri de hesaba katıldığında, ortalamada 16.9 cm uzadı. Ortalama kemik iyileşme indeksi (bone healing index, BHI) femurlar için 31.2 (dağılım: 17.4-43.3) gün/cm, tibialar için 34.3 (dağılım: 19.5-60.0) gün/cm olarak saptandı. Tespit sonrası görülen 16 komplikasyon şu şekilde sıralandı; 3 gecikmiş matürasyon, 3 pin dibi enfeksiyonu, 5 geçici fibula felci, 5 rejenere kırık, 1 geç varus deformitesi, 1 diz kontraktürü ve 1 diz çıkığına sekonder diz kontraktürü. Fonksiyonel skorlar açısından 78 segmentte mükemmel, 8 segmentte iyi, 1 segmentte orta ve 1 segmentte kötü sonuç alındı.

Çıkarımlar: Akondroplastik hastaların femur ve tibialarının bilateral ve eş zamanlı olarak uzatılması toplam tedavi ve eksternal tespit sürelerinde azalmaya yol açarken, komplikasyon oranı düşük seviyelerde seyretmektedir.

Kaynakça

  • Aldegheri R, Trivella G, Renzi-Brivio L, Tessari G, Agos- tini S, Lavini F. Lengthening of the lower limbs in achon- droplastic patients. A comparative study of four tech- niques. J Bone Joint Surg Br 1988;70:69-73.
  • Aldegheri R. Distraction osteogenesis for lengthening of the tibia in patients who have limb-length discrepancy or short stature. J Bone Joint Surg Am 1999;81:624-34.
  • Aldegheri R, Dall’Oca C. Limb lengthening in short stat- ure patients. J Pediatr Orthop B 2001;10:238-47. CrossRef
  • Ganel A, Horoszowski H. Limb lengthening in children with achondroplasia. Differences based on gender. Clin Orthop Relat Res 1996;332:179-83. CrossRef
  • Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990;250:81-104.
  • Yasui N, Kawabata H, Kojimoto H, Ohno H, Matsuda S, Araki N, et al. Lengthening of the lower limbs in patients with achondroplasia and hypochondroplasia. Clin Orthop Relat Res 1997;344:298-306. CrossRef
  • Vaidya SV, Song HR, Lee SH, Suh SW, Keny SM, Telang SS. Bifocal tibial corrective osteotomy with lengthening in achondroplasia: an analysis of results and complications. J Pediatr Orthop 2006;26:788-93. CrossRef
  • Venkatesh KP, Modi HN, Devmurari K, Yoon JY, Anu- pama BR, Song HR. Femoral lengthening in achondro- plasia: magnitude of lengthening in relation to patterns of callus, stiffness of adjacent joints and fracture. J Bone Joint Surg Br 2009;91:1612-7. CrossRef
  • Sabharwal S, Paley D, Bhave A, Herzenberg JE. Growth patterns after lengthening of congenitally short lower limbs in young children. J Pediatr Orthop 2000;20:137- 45. CrossRef
  • Lee DY, Chung CY, Choi IH. Longitudinal growth of the rabbit tibia after callotasis. J Bone Joint Surg Br 1993;75:898-903.
  • Sabharwal S, Harten RD, Sabatino C, Yun JS, Mun- jal K. Selective soft tissue release preserves growth plate architecture during limb lengthening. J Pediatr Orthop 2005;25:617-22. CrossRef
  • Noonan KJ, Leyes M, Forriol F, Cañadell J. Distraction os- teogenesis of the lower extremity with use of monolateral external fixation. A study of two hundred and sixty-one femora and tibiae. J Bone Joint Surg Am 1998;80:793- 806.
  • Song SH, Agashe MV, Huh YJ, Hwang SY, Song HR. Physeal growth arrest after tibial lengthening in achon- droplasia: 23 children followed to skeletal maturity. Acta Orthop 2012;83:282-7. CrossRef
  • De Deyne PG1, Meyer R, Paley D, Herzenberg JE. The ad- aptation of perimuscular connective tissue during distrac- tion osteogenesis. Clin Orthop Relat Res 2000;379:259- 69. CrossRef
  • Belthur MV, Paley D, Jindal G, Burghardt RD, Specht SC, Herzenberg JE. Tibial lengthening: extraarticular cal- caneotibial screw to prevent ankle equinus. Clin Orthop Relat Res 2008;466:3003-10. CrossRef

Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients

Yıl 2014, Cilt: 48 Sayı: 2, 157 - 163, 18.04.2014
https://doi.org/10.3944/AOTT.2014.3274

Öz

Objective: The aim of this study was to analyze the results and complications of simultaneous bilateral femoral and tibial lengthening in achondroplastic patients.

Methods: The study included the 44 femora and 44 tibiae of 22 achondroplastic patients (16 females, 6 males; mean age: 6.36 years, range: 3 to 11 years) that underwent simultaneous lengthening. Orthofix LRS monolateral fixators were used for femoral lengthening and either Ilizarov-type or hexapod-type circular external fixators for tibial lengthening. Tenotomies of the hip flexors and the Achilles tendon were performed to prevent injury to the growth plates and to prevent joint contractures. Results and complications were evaluated according to Paley’s scoring and complication systems.

Results: Average follow-up time was 35 (range: 26 to 76) months. The femora were lengthened by an average of 7.07 cm (46.1%), and the tibiae by an average of 6.64 cm (52.9%). Patients gained an average of 16.9 cm in height, including physiological growth. The mean bone-healing index (BHI) was 31.2 days/cm for the femora (range: 17.4 to 43.3 days/cm) and 34.3 days/cm for the tibiae (range: 19.5 to 60.0 days/cm). Complications included 3 delayed maturations, 3 pin track infections, 5 transient fibular paralyses, 5 regenerate fractures, 1 late varus deformity, 1 knee contracture and 1 knee contracture secondary to knee dislocation. Functional scores were excellent in 78 segments, good in 8, fair in 1 and poor in one. There was no growth inhibition related to the lengthening.

Conclusion: Bilateral simultaneous lengthening of the femora and tibiae in achondroplastic patients provided a reduction in total treatment and external fixation time, with a low rate of complications.

Kaynakça

  • Aldegheri R, Trivella G, Renzi-Brivio L, Tessari G, Agos- tini S, Lavini F. Lengthening of the lower limbs in achon- droplastic patients. A comparative study of four tech- niques. J Bone Joint Surg Br 1988;70:69-73.
  • Aldegheri R. Distraction osteogenesis for lengthening of the tibia in patients who have limb-length discrepancy or short stature. J Bone Joint Surg Am 1999;81:624-34.
  • Aldegheri R, Dall’Oca C. Limb lengthening in short stat- ure patients. J Pediatr Orthop B 2001;10:238-47. CrossRef
  • Ganel A, Horoszowski H. Limb lengthening in children with achondroplasia. Differences based on gender. Clin Orthop Relat Res 1996;332:179-83. CrossRef
  • Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990;250:81-104.
  • Yasui N, Kawabata H, Kojimoto H, Ohno H, Matsuda S, Araki N, et al. Lengthening of the lower limbs in patients with achondroplasia and hypochondroplasia. Clin Orthop Relat Res 1997;344:298-306. CrossRef
  • Vaidya SV, Song HR, Lee SH, Suh SW, Keny SM, Telang SS. Bifocal tibial corrective osteotomy with lengthening in achondroplasia: an analysis of results and complications. J Pediatr Orthop 2006;26:788-93. CrossRef
  • Venkatesh KP, Modi HN, Devmurari K, Yoon JY, Anu- pama BR, Song HR. Femoral lengthening in achondro- plasia: magnitude of lengthening in relation to patterns of callus, stiffness of adjacent joints and fracture. J Bone Joint Surg Br 2009;91:1612-7. CrossRef
  • Sabharwal S, Paley D, Bhave A, Herzenberg JE. Growth patterns after lengthening of congenitally short lower limbs in young children. J Pediatr Orthop 2000;20:137- 45. CrossRef
  • Lee DY, Chung CY, Choi IH. Longitudinal growth of the rabbit tibia after callotasis. J Bone Joint Surg Br 1993;75:898-903.
  • Sabharwal S, Harten RD, Sabatino C, Yun JS, Mun- jal K. Selective soft tissue release preserves growth plate architecture during limb lengthening. J Pediatr Orthop 2005;25:617-22. CrossRef
  • Noonan KJ, Leyes M, Forriol F, Cañadell J. Distraction os- teogenesis of the lower extremity with use of monolateral external fixation. A study of two hundred and sixty-one femora and tibiae. J Bone Joint Surg Am 1998;80:793- 806.
  • Song SH, Agashe MV, Huh YJ, Hwang SY, Song HR. Physeal growth arrest after tibial lengthening in achon- droplasia: 23 children followed to skeletal maturity. Acta Orthop 2012;83:282-7. CrossRef
  • De Deyne PG1, Meyer R, Paley D, Herzenberg JE. The ad- aptation of perimuscular connective tissue during distrac- tion osteogenesis. Clin Orthop Relat Res 2000;379:259- 69. CrossRef
  • Belthur MV, Paley D, Jindal G, Burghardt RD, Specht SC, Herzenberg JE. Tibial lengthening: extraarticular cal- caneotibial screw to prevent ankle equinus. Clin Orthop Relat Res 2008;466:3003-10. CrossRef
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orijinal Makale
Yazarlar

Mehmet Kocaoglu Bu kişi benim

Fikri Erkal Bilen Bu kişi benim

Goksel Dikmen Bu kişi benim

Halil İbrahim Balcı Bu kişi benim

Levent Eralp Bu kişi benim

Yayımlanma Tarihi 18 Nisan 2014
Yayımlandığı Sayı Yıl 2014 Cilt: 48 Sayı: 2

Kaynak Göster

APA Kocaoglu, M., Bilen, F. E., Dikmen, G., Balcı, H. İ., vd. (2014). Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients. Acta Orthopaedica Et Traumatologica Turcica, 48(2), 157-163. https://doi.org/10.3944/AOTT.2014.3274
AMA Kocaoglu M, Bilen FE, Dikmen G, Balcı Hİ, Eralp L. Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients. Acta Orthopaedica et Traumatologica Turcica. Nisan 2014;48(2):157-163. doi:10.3944/AOTT.2014.3274
Chicago Kocaoglu, Mehmet, Fikri Erkal Bilen, Goksel Dikmen, Halil İbrahim Balcı, ve Levent Eralp. “Simultaneous Bilateral Lengthening of Femora and Tibiae in Achondroplastic Patients”. Acta Orthopaedica Et Traumatologica Turcica 48, sy. 2 (Nisan 2014): 157-63. https://doi.org/10.3944/AOTT.2014.3274.
EndNote Kocaoglu M, Bilen FE, Dikmen G, Balcı Hİ, Eralp L (01 Nisan 2014) Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients. Acta Orthopaedica et Traumatologica Turcica 48 2 157–163.
IEEE M. Kocaoglu, F. E. Bilen, G. Dikmen, H. İ. Balcı, ve L. Eralp, “Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients”, Acta Orthopaedica et Traumatologica Turcica, c. 48, sy. 2, ss. 157–163, 2014, doi: 10.3944/AOTT.2014.3274.
ISNAD Kocaoglu, Mehmet vd. “Simultaneous Bilateral Lengthening of Femora and Tibiae in Achondroplastic Patients”. Acta Orthopaedica et Traumatologica Turcica 48/2 (Nisan 2014), 157-163. https://doi.org/10.3944/AOTT.2014.3274.
JAMA Kocaoglu M, Bilen FE, Dikmen G, Balcı Hİ, Eralp L. Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients. Acta Orthopaedica et Traumatologica Turcica. 2014;48:157–163.
MLA Kocaoglu, Mehmet vd. “Simultaneous Bilateral Lengthening of Femora and Tibiae in Achondroplastic Patients”. Acta Orthopaedica Et Traumatologica Turcica, c. 48, sy. 2, 2014, ss. 157-63, doi:10.3944/AOTT.2014.3274.
Vancouver Kocaoglu M, Bilen FE, Dikmen G, Balcı Hİ, Eralp L. Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients. Acta Orthopaedica et Traumatologica Turcica. 2014;48(2):157-63.