Abstract
Various fixators are used today for the correction of the long bones deformities in patients with osteogenesis imperfecta (OI) with giving preference to intramedular telescopic fixators (ITF). But none of them provides rotation stability, which causes additional immobilization in the postoperative period. In Sytenko Institute of Spine and Joint pathology ITF that meets the principles of axial and rotation stability has been developed. Objective: to perform a comparative study of surgical treatment in patients with OI using two versions of the ITF. Methods: 9 patients with OI has been studied, who underwent surgical treatment of combined deformation in 30 segments of upper and lower limbs using ITF: humerus — 2 segments (6.7%), femur — 15 (50 %), tibia -13 (43.3 %). Patients were divided into two groups: — 3 children (33.3 %), which had 5 rotation unstable ITF, II — 6 (66.7 %) and 25 patient had rotation stable ITF (83.3 %). Follow-up period ranged from 1 month to 5 years and 2 months. Results: growth segments in length recorded in all patients and was equal to 1.2 to 21.2 mm (thigh), from 1.7 to 9.3 mm (tibia). It was recorded lengthening ITF: femoral segment — from 1.0 to 20.6 mm, tibia — from 1.3 to 9 mm. In group II patients had improved, and in some cases, the restoration of functional motor skills and walking (improved support-kinematic function of the lower extremities by 5 classes, and in 3 cases by 7). In 5 patients (55.5 %), which didn't walk preoperatively had possibility to vertical standing and walking. We found declined percentage of complications associated with the use of fixators, after the establishment of the ITF rotational stability. Conclusions: The use of ITF provides rotational stability, restores function of limbs and walking, early start of rehabilitation, reduced complications rate, self improvement and quality of patients life.
Highlights
Various fixators are used today for the correction of the long bones deformities in patients with osteogenesis imperfecta (OI) with giving preference to intramedular telescopic fixators (ITF)
Patients were divided into two groups: — 3 children (33.3 %), which had 5 rotation unstable ITF, II — 6 (66.7 %) and 25 patient had rotation stable ITF (83.3 %)
We found declined percentage of complications associated with the use of fixators, after the establishment of the ITF rotational stabi lity
Summary
В период с сентября 2008 по февраль 2016 года 9 пациентам (1 мальчик, 8 девочек, в возрасте от 4,2 до 16 лет) с НО проведено хирургическое лечение с применением ИТФ комбинированных деформаций 30 сегментов верхних и нижних конечностей: плечо — 2 (6,7 %), бедро — 15 (50 %), голень — 13 (43,3 %). Среди них было 8 пациентов (88,9 %), которые не могли вертикально стоять из-за выраженной деформации нижних конечностей и их неопорности (передвигались с помощью вспомогательных ортопедических устройств, либо функция передвижения отсутствовала). При рентгенологическом исследовании определяли степень и скорость формирования костной мозоли в зонах остеотомий (сращение фрагментов костей оперированных сегментов отмечали через 3–4 недели после хирургического вмешательства), рост сегмента конечности, корректность расположения ИТФ, осевые параметры сегмента конечности и удлинение фиксатора. Изучены указанные параметры до хирургического вмешательства и каждые 6 мес. после него
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