六轴外固定器延长后置入髓内钉术治疗胫骨短缩

Lengthening and then nailing with hexapod fixators for tibial shortening deformity

目的:评估六轴外固定器延长后置入髓内钉术(LATN)治疗胫骨短缩的有效性和安全性。方法:回顾性分析2018年4月至2022年9月采用LATN治疗的10例胫骨短缩患者的临床资料。其中男6例,女4例,年龄17~33岁,平均(23.5±6.2)岁。测量手术前后胫骨近端内侧角(MPTA)和机械轴过胫骨平台位置的百分比。末次随访时记录踝关节屈伸活动度、使用基于外固定器联合髓内钉延长术(LON)评分加以改良的积水潭(JST)胫骨延长评分进行疗效评估,并采用Likert量表对患者满意度进行评估,同时观察并发症发生情况。分析LATN疗效指标与年龄、预期和实际延长长度的相关性。结果:10例患者全部获得随访,随访时间9~59个月,平均(35.2±12.8)个月。延长长度为2.0~10.6 cm,平均(6.2±2.3)cm;带外固定器时间为1.9~6.1个月,平均(4.7±1.2)个月,外固定指数(EFI)为0.6~1.4个月/厘米,中位数(四分位数)为0.71(0.67,1.00)个月/厘米。骨愈合时间为4.2~14.4个月,平均(8.6±2.8)个月,骨愈合指数(BHI)为1.0~2.6个月/厘米,平均(1.5±0.5)个月/厘米。手术前后MPTA、机械轴线通过胫骨平台位置的百分比差异均无统计学意义(P均>0.05)。末次随访时踝关节活动度较术前平均减小9.0°±3.2°,且差异有统计学意义(P<0.05);JST胫骨延长评分显示优7例,良3例,中和差均0例;患者满意度为非常满意9例,满意1例。无一例出现深部感染。相关分析结果显示,年龄、实际延长长度与BHI均呈正相关(r=0.679、P=0.031,r=0.640、P=0.046),实际延长长度与EFI呈负相关(r=−0.688,P=0.028)。结论:LATN是安全、有效的胫骨延长手段。

Objective:To evaluate the safety and efficacy of lengthening and then nailing(LATN)with hexapod fixators in treating tibial shortening.Methods:We retrospectively analyzed clinical data from 10 patients with tibial shortening treated with LATN from April 2018 to September 2022.There were 6 males and 4 females,aged 17 to 33 years,with an average age of(23.5±6.2)years.The medial proximal tibial angel(MPTA)and the percentage of the mechanical axis passing through the tibial plateau were measured before and after the operation.At the final follow-up,treatment efficacy was evaluated using the JST tibial lengthening score,which is a modified version of the lengthening over nail(LON)score.Additionally,patient satisfaction was evaluated using a Likert scale.Spearman correlation analysis was used to analyze the correlations between postoperative parameters and age,expected length,and actual lengthening achieved.Results:All patients were followed up for 9 to 59 months,with an average of(35.2±12.8)months.The lengthening achieved was 2.0-10.6 cm,with an average of(6.2±2.3)cm.The duration of external fixation was 1.9-6.1 months,with an average of(4.7±1.2)months.The external fixation index(EFI)was 0.6-1.4 months/cm,and the median(interquartile range)was 0.71(0.67,1.00)months/cm.The bone healing time was 4.2-14.4 months,with an average of(8.6±2.8)months.The bone healing index(BHI)was 1.0-2.6 months/cm,with an average of(1.5±0.5)months/cm.At the last follow-up,the JST tibial lengthening score showed 7 cases as excellent,3 as good,and no fair or bad cases.Nine patients were very satisfied with the results and one patient was satisfied.There was a statistically significant decreases in ankle range of motion,with an average decrease of 9.0°±3.2°(P<0.05).No significant difference was observed in the MPTA or the percentage of the mechanical axis passing through the tibial plateau before and after surgery(all P>0.05).Correlation analysis showed that age was correlated with the BHI,and expected lengthening was correlated with the EFI.No cases of deep infection were found.Conclusions:The LATN technique is a safe and effective method for achieving significant tibial lengthening.