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首页> 外文期刊>Archives of orthopaedic and trauma surgery. >Comparison of fixator-assisted nailing versus circular external fixator for bone realignment of lower extremity angular deformities in rickets disease.
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Comparison of fixator-assisted nailing versus circular external fixator for bone realignment of lower extremity angular deformities in rickets disease.

机译：固定器辅助钉与圆形外固定器在病中下肢角畸形骨复位的比较。

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PURPOSE: In rickets patients, limb deformities are usually multiapical and complex even with medical treatment; residual deformities remain necessitating surgical correction. In our study we aim to compare the results of correction of lower limb deformities, in rickets patients, treated with circular external fixator versus fixator-assisted intra-medullary nail. MATERIALS AND METHODS: Seventeen rickets patients, with 39 deformed lower extremity segments (femur and or tibia), underwent deformity correction procedures in our institution. Ten patients with 26 segments were treated using fixator-assisted nailing. Nine patients with 17 segments were treated using Ilizarov technique with circular frame. All patients were evaluated by long-standing true anteroposterior and lateral orthoroentgenograms of lower extremities preoperatively. Joint alignment, joint orientation, and apices of deformities were calculated and noted. The postoperative results of MAD, MPTA, LDFA, PPPTA and functional criteria were compared with preoperative values and assessments made in SPSS 13.0 for Windows by using McNemar, Pearson Chisquare, and Fisher exact statistical tests. RESULTS: Mean age for the fixator-assisted nailing (FAN) group patients at the time of surgery was 23.8 years (14-37 years). There were 16 femur and 10 tibiae operated on 6 female and 4 male patients. The mean follow up time is 42.6 months (6-71 months). In the Ilizarov group patients the mean age at the time of surgery was 16.7 years (13-22 years). There were 14 tibiae and 3 femur operated on 6 female and 3 male patients. The mean follow-up time was 19 months (6-48 months). Results were evaluated according to the Paley et al. classification of bone and functional results. According to those criteria we had 1 fair, 1 good, and 7 excellent bone results and 1 fair, 1 good, and 7 excellent functional results in the circular ring fixator group. In the FAN group we found 3 good and 7 excellent bone results; 1 fair, 2 good, and 7 excellent functional results. Nearly all patients complained of pain, limping, instability, and walking problems at their first preoperative visit. In both groups there was no union problem; in the FAN group, in one patient correction loss occurred and in another one screw loosening was encountered; in the Ilizarov group, 66% of patients had pin tract infections and one premature fibula consolidation occurred. Statistical analysis revealed no significant difference between two groups in correction ratios.(pearson chi square p = 0.332 for MAD; pearson chi square p = 0.477 for LDFA; Paley functional criteria fisher exact p = 0.684). CONCLUSION: The results indicated that fixator-assisted nailing carries deformity correction accuracy comparable with Ilizarov-type external fixators. FAN provides great patient comfort and the total treatment time is less. In patients with rickets, the retained IM nail can further provide protection against recurrence even if the metabolic pathology reoccurs.
机译：目的：在病患者中，即使经过药物治疗，四肢畸形通常也是多尖且复杂的。残留的畸形仍然需要手术矫正。在我们的研究中，我们旨在比较使用圆形外固定器与固定器辅助的髓内钉治疗的病患者下肢畸形的矫正结果。材料与方法：17例病患者，其下肢畸形为39个（股骨和/或胫骨），在我院接受了畸形矫正程序。用固定器辅助钉治疗10例具有26个节段的患者。 9例17个节段的患者采用Ilizarov技术进行了圆形框架治疗。术前通过长期的真实下肢真实前后位和侧位正位图对所有患者进行了评估。计算并记录关节对准，关节方向和畸形顶点。使用McNemar，Pearson Chisquare和Fisher精确统计检验，将MAD，MPTA，LDFA，PPPTA和功能标准的术后结果与Windows SPSS 13.0中的术前值和评估结果进行了比较。结果：固定器辅助钉（FAN）组患者手术时的平均年龄为23.8岁（14-37岁）。 6例女性和4例男性患者进行了16例股骨和10例胫骨手术。平均随访时间为42.6个月（6-71个月）。 Ilizarov组患者手术时的平均年龄为16.7岁（13-22岁）。 6例女性和3例男性患者进行了14例胫骨手术和3例股骨手术。平均随访时间为19个月（6-48个月）。根据Paley等人的评估结果。骨骼分类和功能结果。根据这些标准，在圆环固定器组中，我们获得了1个公平，1个良好和7个出色的骨骼结果，以及1个公平，1个良好和7个出色的功能结果。在FAN组中，我们发现了3个好骨骼和7个出色的骨骼结果; 1个正常，2个良好和7个出色的功能结果。几乎所有患者在第一次术前就抱怨疼痛，行，不稳定和行走困难。两组都没有工会问题。在FAN组中，一名患者发生矫正损失，另一名患者发生螺钉松动;在Ilizarov组中，有66％的患者患有针道感染，并发生了1根腓骨过早合并。统计分析表明，两组校正率之间无显着差异（MAD的皮尔逊卡方p = 0.332; LDFA的皮尔逊卡方p = 0.477; Paley功能标准费舍尔精确值p = 0.684）。结论：结果表明，固定器辅助的钉具有与Ilizarov型外固定器相当的畸形矫正精度。 FAN为患者提供了极大的舒适感，总治疗时间更少。在患有病的患者中，即使新陈代谢病变再次发生，保留的IM钉也可以进一步防止复发。

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