DEXA as a Predictor of Fixator Removal in Distraction Osteogenesis
DEXA as a Predictor of Fixator Removal in Distraction Osteogenesis
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DOI：
10.1007/s11999-008-0514-y
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发表时间：
2008-12-01
影响因子：
4.2
通讯作者：
Hamdy, Reggie C.
中科院分区：
文献类型：
--
作者：
Saran, Neil;Hamdy, Reggie C.
在延长手术后过早取出固定物可导致再生骨逐渐弯曲或急性骨折。我们回顾了1997年至2005年间26例接受28例肢体延长的患者的记录，以评估延长后再生骨折率和骨愈合指数，并使用双能x线吸收仪（DEXA）来帮助决定何时拆除固定架。16名男性和10名女性患者平均年龄为12.3岁，平均延长5.2厘米（范围3-9.1厘米）。延长了19根股骨和9根胫骨。分析连续每月DEXA扫描的骨矿物质密度。评估骨愈合指数和固定架拆除后并发症。当骨密度稳定在10%以下时取出固定物，x线平片显示没有明显的缺陷妨碍取出固定物。器械取出后无再生骨折，仅有1例延长骨近端骨折，愈合指数平均为47 d/cm（范围20 ~ 73 d/cm）。在延长的巩固阶段使用连续DEXA扫描，骨折发生率低（3.6%），同时保持可接受的骨愈合指数，而无需过度增加固定时间。
Premature removal of the fixator after a lengthening procedure can result in gradual bending or acute fracture of the regenerate. We reviewed the records of 26 patients who underwent 28 limb lengthenings between 1997 and 2005 to assess the post lengthening regenerate fracture rate and bone healing index when using dual energy xray absorptiometry (DEXA) to aid in deciding on when to remove the fixator. Sixteen male and 10 female patients with an average age at lengthening of 12.3 years underwent an average lengthening of 5.2 cm (range, 3-9.1 cm). Nineteen femurs and nine tibiae were lengthened. Serial monthly DEXA scans were analyzed for bone mineral density. Bone healing indices and post fixator removal complications were assessed. The fixators were removed once the bone mineral density had plateaued to a less than 10% increase and plain radiographs showed no obvious defects precluding fixator removal. There were no regenerate fractures and only one fracture in the proximal segment of the lengthened bone after apparatus removal and the healing index for the series averaged 47 d/cm (range, 20-73 d/cm). Using serial DEXA scans during the consolidation phase of lengthening has a low rate (3.6%) of fractures while maintaining an acceptable bone healing index without excessively increasing fixation time.