矮身材和侏儒症的双下肢内外结合延长术(附638例报告)

Internal-external fixation for lower limbs in the treatment of short statures

[目的]为低于身高均值2个标准差以下的成人矮身材、侏儒症、有增高愿望的志愿者实施双下肢延长术,满足患者对合理身高的追求,以增加他们的自信和融入社会(求职、婚姻等)的机遇.[方法]根据Ilizarov提出的牵拉成骨技术(distraction osteogenesis,DO),应用自行研制的带锁髓内钉与外固定延长器系统[1](locking intramedullary nail with external fixator for limbs lengthening,IEFL),为638例矮身材和侏儒症实施双下肢延长术.术后第8d始,以0.5～1.0 mm/d的速度延长,达到所需增加高长度后,插入髓内钉远端锁钉,拆除延长器.在延长期和骨功能重建期内,增加应力刺激,进行规范有益的功能训练,促进骨和肢体功能恢复.[结果]本组病例随访时间2.5～8a,平均4 a,增加身高8～26 cm,平均9.6 cm.根据客观、功能、主观、症状4个指标评分评定,优99.53%,良0.31%,差0.16%.发生并发症48例(56个肢体),占7.52%,其中轻度5.96%,中度1.09%,重度0.47%,至今尚未发现后遗症.[结论]IEFL技术是在Ilizarov生物学理论、技术和器械基础上的重大创新与完善,是进行大幅度(＞10%)肢体延长(增高)的一种安全、有效方法,对伴有膝内翻者还能同期矫正畸形.

[ Objective ] The purpose of the surgical operation is to increase the height of adult patients who are 2SD below the average height so as to satisfy their need for a normal body height, to built up their confidence in social activities and to increase their chance of success in marriage and job hunting. [ Method] Based on Ilizarov＇s Tension-Stress theory and his technical principles as well as the physical structure of Chinese population, the operations were performed on 638 adults using self-designed, self-made tibial intramedullary locking nail system and dynamic synchronous limb lengthening device. The limbs were lengthened at a speed of 0. 5 -1 mm/d starting from the 8^th day after the operation. When the ideal body height was acquired, the distal locking screws were locked and lengthening device removed. In order to provide the stress stimulus needed to mineralize the bone, proper weight-bearing exercises were done during the process of limb lengthening and recovery until the newly grown bone was completely mineralized. [ Result] The follow-up cases study of the group lasted 2. 5 - 7, 5 years, averaging 3 years and 2 months. The height increasing ranged from 8 - 26 cm, averaging 9. 6 cm. There were 48 cases of complications （ 56 limbs）, taking up 7. 52% （ minor 7. 05% , serious 0.47% ）. No sequel has been found so far. Of all the cases, 99. 54% were rated excellent, 0. 45% good and 0. 2% bad. [ Conclusion] The system is a significant innovation and perfection on the base of Ilizarov＇s theory of biology, improvements of techniques and apparatus. It is a safe and effective way for lengthening of both limbs to a great extent （ 〉 10% ）. It also rectifies the deformity of out knee.