Mehmet KOCAOĞLU, Fikri Erkal BİLEN, GÖKSEL DİKMEN, HALİL İBRAHİM BALCI, Levent ERALP

Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients

Amaç: Bu çalışmada akondroplastik hastaların femur ve tibialarının bilateral ve eş zamanlı olarak uzatılmasının doğuracağı sonuçlar ve komplikasyonlar analiz edildi. Çalışma planı: Çalışmaya 44 femur ve 44 tibiasında eş zamanlı uzatma yapılan 22 akondroplastik hasta (16 kız, 6 erkek; ortalama yaş: 6.36, dağılım: 3-11) alındı. Femurların uzatılması için Orthofix LRS monolateral fiksatörler kullanılırken, tibiaların uzatılmasında Ilizarov tipi veya hexapod tipi sirküler eksternal fiksatörlerden yararlanıldı. Kalça fleksörleri ve Aşil tendonunda gerçekleştirilen tenotomilerle, büyüme plaklarının hasar görmesinin ve eklem kontraktürlerinin önüne geçildi. Sonuçlar ve komplikasyonlar Paley sınıflaması ve komplikasyon sistemlerine göre değerlendirildi. Bulgular: Hastaların ortalama takip süresi 35 (dağılım: 26-76) ay idi. Femurlar ortalama 7.07 cm (%46.1) uzatılırken, tibialardaki ortalama uzama 6.64 cm (%52.9) olarak ölçüldü. Hastaların boyu, fizyolojik büyümeleri de hesaba katıldığında, ortalamada 16.9 cm uzadı. Ortalama kemik iyileşme indeksi (bone healing index, BHI) femurlar için 31.2 (dağılım: 17.4-43.3) gün/cm, tibialar için 34.3 (dağılım: 19.5-60.0) gün/cm olarak saptandı. Tespit sonrası görülen 16 komplikasyon şu şekilde sıralandı; 3 gecikmiş matürasyon, 3 pin dibi enfeksiyonu, 5 geçici fibula felci, 5 rejenere kırık, 1 geç varus deformitesi, 1 diz kontraktürü ve 1 diz çıkığına sekonder diz kontraktürü. Fonksiyonel skorlar açısından 78 segmentte mükemmel, 8 segmentte iyi, 1 segmentte orta ve 1 segmentte kötü sonuç alındı. Çıkarımlar: Akondroplastik hastaların femur ve tibialarının bilateral ve eş zamanlı olarak uzatılması toplam tedavi ve eksternal tespit sürelerinde azalmaya yol açarken, komplikasyon oranı düşük seviyelerde seyretmektedir.

Akondroplastik hastalarda femur ve tibianın bilateral ve eş zamanlı uzatılması

Objective: The aim of this study was to analyze the results and complications of simultaneous bilateral femoral and tibial lengthening in achondroplastic patients. Methods: The study included the 44 femora and 44 tibiae of 22 achondroplastic patients (16 females, 6 males; mean age: 6.36 years, range: 3 to 11 years) that underwent simultaneous lengthening. Orthofix LRS monolateral fixators were used for femoral lengthening and either Ilizarov-type or hexapod-type circular external fixators for tibial lengthening. Tenotomies of the hip flexors and the Achilles tendon were performed to prevent injury to the growth plates and to prevent joint contractures. Results and complications were evaluated according to Paley’s scoring and complication systems. Results: Average follow-up time was 35 (range: 26 to 76) months. The femora were lengthened by an average of 7.07 cm (46.1%), and the tibiae by an average of 6.64 cm (52.9%). Patients gained an average of 16.9 cm in height, including physiological growth. The mean bone-healing index (BHI) was 31.2 days/cm for the femora (range: 17.4 to 43.3 days/cm) and 34.3 days/cm for the tibiae (range: 19.5 to 60.0 days/cm). Complications included 3 delayed maturations, 3 pin track infections, 5 transient fibular paralyses, 5 regenerate fractures, 1 late varus deformity, 1 knee contracture and 1 knee contracture secondary to knee dislocation. Functional scores were excellent in 78 segments, good in 8, fair in 1 and poor in one. There was no growth inhibition related to the lengthening. Conclusion: Bilateral simultaneous lengthening of the femora and tibiae in achondroplastic patients provided a reduction in total treatment and external fixation time, with a low rate of complications.

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