The role of guided growth as it relates to limb lengthening.
The role of guided growth as it relates to limb lengthening.
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DOI：
10.1007/s11832-016-0779-8
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发表时间：
2016-12
影响因子：
1.4
通讯作者：
Stevens, Peter M.
中科院分区：
文献类型：
--
作者：
Stevens, Peter M.
几十年来，肢体延长的经典适应症一直保留用于预期在成熟时达到或超过5 cm的不等长。保留骨骺固定术用于2-5 cm范围内的差异。随着固定器的日益复杂，包括导轨、六足和混合固定器，复杂畸形可以在实现中度至极端延长的同时得到矫正。最近，伸缩式髓内棒的迭代进一步加强了我们的医疗设备。同时，永久性骨骺固定术技术，无论是开放式还是经皮，都已经产生了更多的功能和可逆性栓系一侧（角）或两侧（长度）的骺板。虽然引导生长和胼胝体扩张术的技术似乎是截然相反的，但为了患者的利益，它们可以以串联或互补的方式使用。如果在骨骼生长期间进行治疗，则必须意识到关于骨骼成熟度的准确评估和最终结果的预测仍然存在问题。因此，存在过度校正或校正不足的可能性。可逆和连续引导生长现在使外科医生能够在相对年轻的年龄开始干预，以优化肢体对齐并减少最终差异。框架应用可能会延迟，或者在某些情况下完全避免。在延长开始时，肢体对线正确，选择性使用伸缩式髓内钉可能优于支架。
For decades, the classic indication for limb lengthening has been reserved for anisomelia that was expected to reach or exceed 5 cm at maturity. Epiphysiodesis was reserved for discrepancies in the 2–5 cm range. With the increasing sophistication of fixators, including rail, hexapod, and hybrid, complex deformities may be corrected simultaneously while moderate to extreme lengthening is achieved. More recently, iterations of telescoping intramedullary rods have further strengthened our armamentarium. Meanwhile, permanent epiphysiodesis techniques, both open and percutaneous, have yielded to more versatile and reversible tethering of one (angle) or both (length) sides of a physis. While the techniques of guided growth and callotasis seem to be diametrically opposed, they may be used in a tandem or complementary fashion, for the benefit of the patient. If treatment is undertaken during skeletal growth, one must be aware that issues remain regarding the accurate assessment of skeletal maturity and prediction of the ultimate outcome. Therefore, there is potential for over- or undercorrection. Reversible and serial guided growth now enable the surgeon to commence intervention at a comparatively young age, for the purpose of optimizing limb alignment and reducing the ultimate discrepancy. Frame application may be delayed or, in some cases, avoided altogether. With the limb properly aligned at the outset of lengthening, elective use of a telescoping intramedullary nail may now be favored over a frame accordingly.
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DOI：
10.1302/0301-620x.93b1.25181
发表时间：
2011-01-01
影响因子：
--
作者：
Eastwood, D. M.;Sanghrajka, A. P.
通讯作者：
Sanghrajka, A. P.
影响因子：
1.7
作者：
Khoury, Joseph G.;Tavares, Joao O.;Sanders, James O.
通讯作者：
Sanders, James O.
影响因子：
1.7
作者：
Métaizeau, JP;Wong-Chung, J;Pasquier, P
通讯作者：
Pasquier, P
影响因子：
1.1
作者：
Machen, MS;Stevens, PM
通讯作者：
Stevens, PM
影响因子：
2.4
作者：
Villemure, Isabelle;Stokes, Ian A. F.
通讯作者：
Stokes, Ian A. F.