Table of Contents

HK J Paediatr (New Series)
Vol 8. No. 4, 2003

HK J Paediatr (New Series) 2003;8:307-317

Paediatric Surgical Forum

Limb Lengthening for Short Stature: A 10-year Clinical Experience
總結矮小身材伴肢端延長:10 年臨床病例

BKW Ng, VWY Hung, JCY Cheng, TP Lam


Abstract

Achondroplasia and hypochondroplasia limb lengthening has become better accepted over last thirty years. We studied our experience on all limb lengthening for short stature over the last ten years. We reviewed patient records, X-rays and Dual Energy X-ray Absorptiometry (DEXA) scans to evaluate the changes in body proportion after limb lengthening and the complications. Fourteen patients with 14 tibial, five femoral and two humeral lengthening procedures were included in this study. Average age at first lengthening procedure was 12.2 (9.6-14.4) years. The average height gained from tibial lengthening alone was 10.47 (2.8-16.3) cm. The average height gained from tibial and femoral lengthening was 19.4 (14.7-25.3) cm. The average humeral length gained was 11 (10.5-11.5) cm. All humeral and femoral lengthenings were performed with the Orthofix uniplanar fixator. In femoral lengthening, mild varus deformity occurred in all patients. Mild pin deformity occurred in all patients. Revisions were not required. More rigid pins are required for femoral lengthening. Tibial lengthenings were accomplished with three different types of fixators. Most complications were encountered in tibial lengthenings. Premature fusion occurred in three patients. One procurvatum and five valgus deformity occurred. Revision to multiplanar construct eliminated deformity. Body proportion has improved between upper and lower segments. Sitting to Standing height ratio decreased from 0.64 (0.59-0.74) to 0.58 (0.54-0.61). Armspan to Standing height ratio worsened from 0.92 before lengthening to 0.84 at follow up and did not have any significant functional effect. The ratios for an achondroplasia patient is 0.72 and 0.84 respectively. Callotasis BMD rises to 40% of original bone indicates premature fusion.

最近三十年已普遍公認軟骨發育不全和軟骨發育低下可導致肢端延長。我們總結近十年來矮小身材伴肢端延長的治療觀察經驗。我們回顧患者的病史記錄,X 射線和雙光子 X 射線吸收掃描 (DEXA) 檢查結果,評價肢端延長和出現併發症後肢體比例的改變。本文 14 例病例,其中脛骨延長 14 例,股骨延長 5 例,肱骨延長 2 例。最早出現肢體延長的平均年齡為 12.2 (9.6-14.4) 歲。單出現脛骨延長的平均身高是 10.47 (2.8-16.3) cm。從脛骨到股骨的平均長度是 19.4 (14.7-25.3) cm。平均肱骨長度是 11 (10.5-11.5) cm。所有的肱骨和股骨延長都經過單板固定器固定。所有的股骨延長患者均出現輕度內翻。所有患者都伴有輕度針刺感覺異常。無需翻修術。股骨延長患者需要較強的針刺激。三種不同類型的固定器用於脛骨延長患者。大部分的併發症出現在脛骨延長患者。三個病例發生未成熟融合。一例前屈,五例外翻異常。多板結構翻修可矯正這些異常。上下肢肢體比例有明顯改善。坐高於身高比例從 0.64 (0.59-0.74) 下降至 0.58 (0.54-0.61)。臂長於身高比例從延長前的 0.92 到隨訪時的 0.84,但對功能並無顯著的影響。軟骨發育不全的患者比例則分別為 0.72 和 0.84。骨礦物質密度上升至原始骨的 40% 提示未成熟融合。

Keyword : Achondroplasia; Femur; Humeral; Lengthening; Tibia

關鍵詞:軟骨發育不全、股骨、肱骨、延長、脛骨

 
 

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