가족성 왜소중에서의 경골연장술 (고식적 Ilizarov방법과 교합 골수정 고정을 병행한 방법과의 비교)

Abstract

Ilizarov technique has been successfully applied to limb lengthening for several decade, one of its main drawback is, however, long application of external fixator over 6 months. To lessen this time, simultaneous intramedullary fixation which convert later to static fixation by insertion of interlocking screws has been proposed. The indication for surgical limb lengthening includes familial short stature below the 3rd percentile. We compared the results of thirteen tibial lengthening with Ilizarov method to that of eleven hybrid methods. The hybrid system is composed of an unreamed AO intramedullary nail (IM) and ring fixator. Once the lengthening is completed, distal interlocking screws were inserted. In the group who were treated by hybrid system, the mean lengthening of tibia was 7.1cm (range, 6.3-9.5), the mean of external fixation period 7 months (range, 5-9), the mean healing index 1.2 month/cm (range, 1.1-1.4). On the other hand, the mean lengthening of tibia was 7.5cm (range, 5-10.3), the mean of external fixation period 9.8 months (range, 6-15), the mean healing index 1.4 month/cm (range, 1.1-1.8) in the group treated by Ilizarov method. Mean follow-up period was 23 months (range 14-47). There was no rotational or angular deformities and no loss of lengthening in the hybrid group. However we experienced three cases of angular deformity at the distraction site during lengthening in Ilizarov group. There was no deep infection in both groups. In the hybrid group we found several advantages such as no deformity, no loss of lengthening, and less scar by early removal of fixator, but some disadvantages such as need of subsequent procedures and limitation in intramedullary nailing.