CAJ | 학술논문

目的探讨可延长髓内钉治疗成骨不全术后股骨再发畸形或骨折的疗效.方法回顾性分析2009年6月至2012年6月采用可延长髓内钉治疗21例成骨不全术后股骨再发畸形或骨折患儿资料,男13例,女8例；年龄9岁6个月至15岁7个月,平均12岁3个月.所有患儿均已行股骨干截骨矫形不可延长髓内钉手术,此次手术距初次手术时间为2～4年,平均3年.所有患儿成长肢体于髓内钉远端部位再次出现畸形或骨折,其中9例为股骨干弯曲畸形,畸形成角度数为10°～30°,平均15°；12例为再发骨折.依据修订后的Sillence分型:Ⅲ型6例,Ⅳ型14例,Ⅴ型1例.21例患儿均在大转子及远端截骨处切开手术,切口长度为2～3 cm,采用可延长髓内钉再次固定骨折及矫正畸形.结果 21例患儿均获得随访,随访时间6～30个月,平均18个月.骨折愈合时间为7～12周,平均8.5周.待X线片示截骨愈合后患儿开始负重行走.所有患儿及其父母均对手术结果及畸形矫正效果表示满意,末次随访时患儿Barthel指数评分由术前平均72.85分(范围,50～90分)提高到术后平均91.42分(范围,80～100分).WeeFIM评分由术前平均55.42分(范围,40～70分)提高到术后平均79.00分(范围,70～86分).10例术前需拐杖辅助行走患儿,随访时可独立行走；6例术前因骨折而卧床患儿中,4例可独立行走,2例需拄拐活动.末次随访时,无一例出现感染、骨髓炎等并发症,无神经、血管损伤病例.结论应用可延长髓内钉小切口手术,对肢体损伤小、出血少、骨折愈合时间短、患儿痛苦小,是治疗成骨不全术后股骨再发畸形或骨折的良好方法.
목적 탐토가연장수내정치료성골불전술후고골재발기형혹골절적료효.방법 회고성분석2009년6월지2012년6월채용가연장수내정치료21례성골불전술후고골재발기형혹골절환인자료,남13례,녀8례；년령9세6개월지15세7개월,평균12세3개월.소유환인균이행고골간절골교형불가연장수내정수술,차차수술거초차수술시간위2～4년,평균3년.소유환인성장지체우수내정원단부위재차출현기형혹골절,기중9례위고골간만곡기형,기형성각도수위10°～30°,평균15°；12례위재발골절.의거수정후적Sillence분형:Ⅲ형6례,Ⅳ형14례,Ⅴ형1례.21례환인균재대전자급원단절골처절개수술,절구장도위2～3 cm,채용가연장수내정재차고정골절급교정기형.결과 21례환인균획득수방,수방시간6～30개월,평균18개월.골절유합시간위7～12주,평균8.5주.대X선편시절골유합후환인개시부중행주.소유환인급기부모균대수술결과급기형교정효과표시만의,말차수방시환인Barthel지수평분유술전평균72.85분(범위,50～90분)제고도술후평균91.42분(범위,80～100분).WeeFIM평분유술전평균55.42분(범위,40～70분)제고도술후평균79.00분(범위,70～86분).10례술전수괴장보조행주환인,수방시가독립행주；6례술전인골절이와상환인중,4례가독립행주,2례수주괴활동.말차수방시,무일례출현감염、골수염등병발증,무신경、혈관손상병례.결론 응용가연장수내정소절구수술,대지체손상소、출혈소、골절유합시간단、환인통고소,시치료성골불전술후고골재발기형혹골절적량호방법.
Objective To evaluate the therapeutic effect of extendable intramedullary nail on children with femoral deformity due to osteogenesis imperfecta.Methods From June 2009 to June 2012,21 patients with femoral deformity due to osteogenesis imperfecta were treated with extendable intramedullary nail.There were 13 males and 8 females,aged from 9 years and 6 months to 15 years and 7 months (average,12 years and 3 months).All children had been performed osteotomy on the shaft of femur and implanted with non-extendable nail before 2-4 years (average,3 years).All children had suffered refracture and deformity,including 9 children with femoral bending deformity and 12 with refracture.The deformity angle ranged from 10°to 30°,with an average of 15°.According to revised Sillence classifications,there were 6 cases with type Ⅲ and 14 with type Ⅳ and 1 case with type Ⅴ.Twenty-one patients were operated with extendable nail for fixing fracture and correcting deformity and incisions were 2-3 cm long and located on the great trochanter and distal osteotomy point.Results All of 21 children were followed up for 6-30 months (average,18 months).The bone healing time was 7-12 weeks (average,8.5 weeks).Patients started to walk after X-ray showing bone union.Parents of 21 children were satisfied with surgical operation effect and deformity correction.The Barthel index score improved from 72.85 (range,50-90 points) preoperatively to 91.42 (range,80-100 points) postoperatively at the latest follow-up of patients.WeeFIM index score increased from preoperative average of 55.42 points (range,40-70points) to postoperative average 79.00 points (range,70-86 points).Ten of all children with stick aid preoperative could walk independently after small incision repairing,and 6 of all children in sickbed preoperative,4 of 6 children could walk independently,2 of 6 children could walk with stick aid.Conclusion Small incision repair with extended intramedullary nail operation therapy is advantaged.It gets less bloody,less damages,less pain,less healing time and walking after removing plaster.