置入式肢体延长髓内钉的研究进展

Research progress of fully implantable intramedullary lengthening nail

肢体不等长可以由先天性或后天获得性原因所致,如生长板停滞、骨髓炎、创伤或肿瘤等。传统的肢体延长技术使用外固定支架,给患者生活造成极大不便,常伴有较高的并发症,如针道感染、固定针引起的软组织切割和疼痛、再生区畸形、支架拆除后再骨折、患者无法耐受支架等。为了缩短外固定的治疗时间,内外结合的手术技术应运而生且不断发展,但仍存在因外固定针道的污染而产生内置物深部感染的风险。早先完全置入式肢体延长髓内钉虽然可以避免外固定佩戴不适、针道感染、贯穿肌肉、切割皮肤等问题,但存在剧烈疼痛、延长过快、授权使用等问题,无法安全、广泛使用。以PRECICE (NuVasive, Inc., Irvine, CA,美国)为代表的最新一代磁力肢体延长髓内钉,凭借其牢固、精准、可控的性能,获得了良好的早期临床疗效,在世界范围内得到了广泛使用,并可能是今后肢体延长、畸形矫正治疗的一个新方向。术前精心的设计、术中手术细节的妥善处理及术后积极规范的康复锻炼是获得良好疗效的保证。

Limb length discrepancy is caused by either congenital or acquired conditions, such as growth arrest, osteomy-elitis, trauma or tumor. Conventional Limb lengthening utilizes external fixators which lead to great inconvenience to patient's daily life. Complications are however common including pin-site infection, soft tissue tethering from the pins and wires resulting in pain, regenerate deformity or fracture after frame removal and intolerance of the frames. In order to reduce the time of external fixator treatment, various combinations techniques of both external and internal fixation have been developed. However, there is still a risk of deep infection of the implant due to contamination of the previous pin tracts of the external fixation. Fullly implantable intramedullary lengthening nail can avoid the problems of external fixator, including discomfort, pin sites infection, muscular transfixation and soft tissue tethering. There are still some problems including serious pain, too quick lengthening and authorization, so the earlier generations of products could not be safely and widely used. The newest generation of magnetic intramedullary lengthening nail represented by PRECICE (NuVasive, Inc., Irvine, CA, USA) has obtained good early clinical results with its stability, precision and controllability. PRECICE is broadly used in the world, which may become the new direction of treatment for limb lengthening and deformity correction. This article aims to review the recent development of fully implantable intramedullary lengthening nail, including clinical application, preoperative planning, key points of surgery, postoperative rehabilitation, and complications.