Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail

Introduction. Lengthening over the nail (LON) combines the advantages of external and internal fixations.The objective was to compare the effectiveness of the application, to assess the structure and frequency of complications in patients treated with lengthening by Ilizarov technique and lengthening over the nail.Methods and materials. We analyzed 55 LON cases and 64 cases lengthening by Ilizarov technique. The duration of the external fixation period, complications and quality of the patient life were compared.Results. The external fixation period in LON group was 4 times less than in the Ilizarov technique group. There were 25 complications (45.5 %) in LON group and 54 complications (84.4 %) in the Ilizarov technique group. Femur lengthening was associated with a greater number of complications in both groups. Pin infections were 2.5 times less frequently in the femur LON group. Knee contractures were only in Ilizarov technique group (11.4 %). Ankle joint contracture was noted with the same frequency during tibial lengthening in both groups. Disorders of the consolidation were 2 times more often in the femur LON group and 5 times more often in the tibial lengthening with Ilizarov technique. Premature fusion was observed only in the LON group. There were 2 times less fractures of the half-pins and wires in the LON group.Conclusions. A reduction of external fixation period in LON group correlates with the 2-fold decrease of complications and an increase of the treatment comfort. LON is promising for wider clinical applications.

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Growth factors of the TGF-b family in blood of achondroplasia patients at stages of orthopedic treatment

ZHurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia» ◽

10.25557/0031-2991.2018.02.70-76 ◽

2018 ◽

pp. 70-76

Author(s):

Е.П. Выхованец ◽

Н.В. Сакулин ◽

С.Н. Лунева ◽

Н.В. Накоскина ◽

О.В. Климов

Keyword(s):

Growth Factors ◽

Limb Lengthening ◽

Serum Levels ◽

Long Bone ◽

Ilizarov Method ◽

Bone Lengthening ◽

Serum Concentrations ◽

Orthopedic Treatment ◽

Tibial Lengthening ◽

Height Increase

Наиболее важной задачей при дистракционном остеосинтезе является создание простых и эффективных способов контроля темпов дистракции позволяющих производить удлинение конечности в оптимальном режиме у различных групп пациентов. Цель исследования - анализ содержания сывороточных концентраций TGFb-1 и TGFb-2, BMP-4 и BMP-6 у лиц при увеличении роста с косметической целью и у пациентов с ахондроплазией на этапах дистракционного остеогенеза при удлинении голени методом Илизарова. Методика. Определение ростовых факторов проводили на комплексе оборудования фирмы Thermofisher (США): детектор Multiscan FC, встряхиватель iEMS, автоматический промыватель планшет WellWash. Для измерения концентрации факторов в сыворотке крови использовали наборы для иммуноферментного анализа (ИФА) eBioscience и RayBiotech Inc. (США). Результаты . Показано, что в сыворотке крови людей с ахондроплазией, еще до какого-либо ортопедического лечения концентрации TGF-b2 и ВМР-4, ниже, а TGF-b1 и ВМР-6, выше, чем концентрации этих факторов у людей при увеличении роста с косметической целью. У последних удлинение конечностей сопровождается возрастанием содержания в сыворотке крови факторов TGF-b1 и TGF-b2 на этапах начала и середины процесса дистракции. У пациентов с ахондроплазией, наблюдается обратная динамика: концентрация данных факторов (ВМР-4 и ВМР-3) в крови ахондропатов к концу дистракции увеличивается в 3,5 и 2 раза соответственно, снижаясь в периоде фиксации. Заключение. Таким образом, у пациентов с ахондроплазией происходит нарушение этапности процессов костного ремоделирования. Elaboration of simple and effective ways for managing the distraction rate to provide an optimum regimen of limb lengthening for different groups of patients is an important task in implementation of transosseous osteosynthesis. The aim of this study was to analyze blood serum concentrations of TGFb-1, TGFb-2, BMP-4, and BMP-6 in individuals undergoing cosmetic height increase and patients with achondroplasia at different stages of distraction osteogenesis in tibial lengthening using the Ilizarov method. Methods. Concentrations of growth factors were measured using a set of Thermofisher (USA) equipment, including a Multiscan FC detector, iEMS Shaker, and automatic WellWash Washer and ELISA kits (eBioscience and RayBiotech Inc., USA). Results. Serum concentrations of TGFb-2 and BMP-4 were lower and TGFb-1 and BMP-6 were higher in achondroplasia patients than in individuals with cosmetic height increase even before any orthopedic treatment. Long bone lengthening for cosmetic height increase was associated with increases in serum levels of TGFb-1 and TGFb-2 at the start and in the middle of distraction. In achondroplasia patients, opposite changes were observed; serum concentrations of BMP-4 and BMP-3 increased 3.5 and 2 times, respectively, by the end of distraction and decreased during fixation. Conclusion. Therefore, we observed a disorder of the stage-by-stage bone remodeling process in achondroplasia patients.

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