Comparison of distraction epiphyseolysis and partial metaphyseal corticotomy in leg lengthening

Summary

We have used Ilazorov's method of distraction epiphyseolysis for leg lengthening since 1977 and his new method of corticotomy or compactotomy since 1983. The first method was carried out in 22 lower limbs with an average lengthening of 8.25 cm (range 4 to 18 cm); included in this group are 2 patients with achondroplasia in whom both legs were lengthened 12 cm. In the second method, a corticotomy is carried out at the metaphyseal-diaphyseal junction followed by distraction in Ilazorov's apparatus (4×0.25 mm a day). We lengthened 30 legs; included are 5 patients who had both legs lengthened from between 8 and 12 cm. In the remainder an average of 7.9 cm of lengthening was achieved (range from 4 to 15 cm). The index for the treatment time per cm achieved (time from operation until full weight-bearing per cm of lengthening) was shorter after distraction epiphyseolysis than after corticotomy. Complications were also a little less after the latter procedure. Distraction epiphyseolysis has to be limited to children from aged 12 years until growth ceases. The advantage with corticotomy is that it can be done at any age from 5 to 30 years. Care is needed in both cases to avoid complications.

Résumé

Nous avons eu recours, pour allonger les membres inférieurs, à la méthode d'Ilizarov de distraction épiphysaire depuis 1977 et à sa nouvelle technique de corticotomie ou compactotomie depuis 1983. La première méthode a été utilisée pour 22 membres inférieurs avec un allongement moyen de 8.25 cm (de 4 à 18 cm). Sont inclus dans ce groupe deux achondroplases chez qui les deux membres inférieurs ont été allongés de 12 cm. Dans la deuxième méthode on pratique une corticotomie au niveau de la jonction dia-métaphysaire, suivie d'une distraction avec l'appareil d'Ilizarov (4×0.25 mm par jour). Nous avons allongé 30 membres inférieurs, parmi lesquels 5 patients qui ont eu un allongement bilatéral compris entre 8 et 12 cm. Chez les autres on a obtenu un allongement moyen de 7.9 cm (de 4 à 15 cm). Le rapport entre la durée du traitement par cm obtenu (c'est à dire le temps écoulé entre l'opération et la mise en charge complète divisé par le nombre de cm d'allongement) est plus faible après distraction epiphysaire qu'après corticotomie. Les complications sont également un peu moins fréquentes avec cette dernière technique. La distraction épiphysaire doit être réservée aux enfants, de l'âge de 12 ans jusqu'à la fin de la croissance. L'avantage de la corticotomie est qu'elle peut être effectuée à n'importe quel âge, de 5 à 30 ans. Dans les deux cas, il faut prendre le plus grand soin pour éviter les complications.

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Franke, J., Hein, G., Simon, M. et al. Comparison of distraction epiphyseolysis and partial metaphyseal corticotomy in leg lengthening. International Orthopaedics 14, 405–413 (1990). https://doi.org/10.1007/BF00182654

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Keywords

  • Public Health
  • Treatment Time
  • Nous Avons
  • Parmi
  • Achondroplasia