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The Minimally Invasive Plate Osteosynthesis (MIPO) Technique with a Locking Compression Plate for Femoral Lengthening
Endo,Hirosuke,Asaumi,Koji,Mitani,Shigeru,Noda,Tomoyuki
Acta Medica Okayama , 2008,
Abstract: A minimally invasive plate osteosynthesis technique using a locking compression plate (LCP) has been used widely in trauma cases. Its advantages are that the MIPO technique does not interfere with the fracture site and thus provides improved biological healing, and that the LCP has excellent angular stability. Its use in bone lengthening, however, has not been established. In such cases, it is desirable to shorten the external skeletal fixation period as much as possible. Here, the MIPO technique using an LCP was applied to femoral distraction osteogenesis in an attempt to shorten the external skeletal fixation period. For femoral lengthening, the MIPO technique was performed in 2 stages. Orthofix external fixators (Orthofix, England) were used to insert screws from the anterolateral side rather than from the lateral side of the femur for bone lengthening. When sufficient callus formation was detected postoperatively at the site of bone lengthening, and the absence of infection was ensured, limb draping was performed, including a whole external fixator, and then the MIPO technique was applied with an LCP. In 3 cases (5 limbs), the average duration of external skeletal fixation was 134days, the average external-fixation index was 24days/cm, and the average consolidation index was 22days/cm. The MIPO technique using an LCP made it possible to shorten the external skeletal fixation-wearing period in femoral lengthening.
微创截骨 Ilizarov 技术结合髓内钉行股骨延长的疗效观察
Effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening
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杨华清,章耀华,韩庆海,彭爱民,郑学建,秦泗河,夏和桃
- , 2018, DOI: 10.7507/1002-1892.201804118
Abstract: 目的探讨微创截骨 Ilizarov 技术结合髓内钉进行股骨延长治疗股骨短缩畸形的效果。 方法将 2013 年 1 月—2016 年 6 月收治并符合选择标准的 71 例股骨短缩畸形患者,随机分为试验组(36 例,采用微创截骨 Ilizarov 技术结合带锁髓内钉进行股骨延长)和对照组(35 例,采用单纯 Ilizarov 技术进行股骨延长)。两组患者年龄、性别、股骨短缩原因、股骨短缩长度、股骨合并畸形比例等一般资料比较差异均无统计学意义( P>0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、延长速度、外固定器佩戴时间、针道感染例数、截骨愈合时间、术后 1 年膝关节活动度。 结果两组患者均获随访,随访时间 12~60 个月,平均 31 个月。试验组 1 例 1 针、对照组 7 例 9 针发生针道感染,均经更换固定针、积极换药、使用抗生素及加强护理后治愈;两组针道感染发生率比较差异有统计学意义( χ 2=5.265, P=0.022)。试验组手术时间长于对照组,术中出血量大于对照组,外固定器佩戴时间、截骨愈合时间及术后 1 年膝关节活动度均优于对照组,差异有统计学意义( P<0.05);两组延长速度比较差异无统计学意义( t=–1.581, P=0.153)。 结论微创截骨 Ilizarov 技术结合髓内钉进行股骨延长虽然增加了手术时间及术中出血量,但显著缩短了患者佩戴外固定器的时间,减少了针道感染概率,改善了术后关节功能。
ObjectiveTo explore the effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening. MethodsSeventy-one patients with femoral shortening deformity who met the selection criteria between January 2013 and June 2016 were randomly divided into trial group (36 cases were treated with minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening) and control group (35 cases were treated with simple Ilizarov technique for femoral lengthening). There was no significant difference in age, gender, causes of femoral shortening, length of femoral shortening, rate of femoral deformity between the two groups ( P>0.05). The operation duration, intraoperative blood loss, lengthening rate, external fixation duration, frequency of pin tract infection, osteotomy healing time, and range of motion (ROM) of knee at 1 year after operation were recorded and compared between the two groups. ResultsThe patients of two groups were followed up 12-60 months (mean, 31 months). Pin tract infection occured in 8 cases (10 pins), including 1 case (1 pin) in the trial group and 7 cases (9 pins) in the control group. There was significant difference in the incidence of pin tract infection between the two groups ( χ 2=5.265, P=0.022). All patients were cured by replacing the fixation pins, changing dressing actively, application of antibiotics, and adequate postoperative care. The operation duration, intraoperative blood loss, external fixation duration, osteotomy healing time, and ROM of knee at 1 year after operation of the trial group were superior to those of the control group, showing significant differences ( P<0.05). There was no significant difference in the lengthening rate between the two groups ( t=–1.581, P=0.153). ConclusionThe minimally invasive osteotomy Ilizarov technique combined with intramedullary nail in femoral lengthening
Recurrence of Diabetic Pedal Ulcerations Following Tendo-Achilles Lengthening  [cached]
Richard D. Weiner,Lee M. Hlad,Danielle R. McKenna
Diabetic Foot & Ankle , 2011, DOI: 10.3402/dfa.v2i0.6417
Abstract: Foot and ankle surgeons are frequently challenged by the devastating systemic consequences of diabetes mellitus manifested through neuropathy, integumentary and joint breakdown, delayed healing, decreased ability to fight infection, and fragile tendon/ligaments. Diabetic neuropathic pedal ulcerations lead to amputations at an alarming rate and also carry a high mortality rate. This article will discuss causes of diabetic pedal ulcerations that persist or recur after tendo-Achilles lengthening and will highlight areas that need to be addressed by the practitioner such as infection, vascular and nutritional status, glucose control, off-loading, biomechanics, and patient compliance.
LIMB LENGTHENING USING WAGNER'S TECHNIQUE  [cached]
A NAZEM KH,A ZARE ZADEH,M MIRBAGHERI
Journal of Research in Medical Sciences , 2002,
Abstract: Introduction. Limb length discrepancy is a disabling anomaly that has many causes including congential, traumatic and paralytic. This study was designed to evaluate results and complications of Wagner's technique in lower limb lenghtening. Methods. In this retrospective study results of the Wagner's technique in seventy paiteints during ten years were studied. Patients were followed for 1 to 9 years after operation with mean of 6 years. Results of operation, complications and paitients statisfaction were recorded. Results. Among the 70 paitents 71% were male and 29% were female. The average time of paitients hospitalization was 6 days for each of first and second satges. The tibial and femoral lengthening were performed in the 84% and 16% respectively. Limb lengthening achieved minimally 4 - 5 cm and maximally 10 cm (mean=6.6cm). In 73%, the cause of discrepancy was paralytic and the other causes were traumatic and congenital anomalies. Complications rate were 47% totally. The most common complication was pin tract infection that was threated conservatively. Results of operation and satisfaction of the patients were good in 85% and fair in 15%. Discussion. The Wagner's method of limb lengthening is a safe and simple method, with low complications and we recommend it for the treatment of lower limb discrepancy yet.
Femoral Lengthening by Ilizarov Technique: Results and Complications  [PDF]
Altaf A. Kawoosa, Suhail Majid, Manzoor A. Halwai, Mohd. Ramzan Mir, G.R. Mir
JK Science : Journal of Medical Education & Research , 2004,
Abstract: Femoral lengthening using Ilizarov technique was performed in ten patients comprising of 6 femalesand 4 males in an age group of 10-19 years with an average shortening of 6.8 cms. The etiology ofshortening was post-infective in 8 patients and post-traumatic in two patients. The desired lengthwas achieved in six patients and in four patients the final limb length discrepancy ranged between 1to 3 cms. The total duration of external fixation ranged from 24 weeks to 90 weeks with an averagehealing index of 6.23 weeks/cm. There were 10 problems and 2 true complications. Temporarydecrease in knee range of motion was a common difficulty encountered during lengthening. Resultswere rated as excellent in five, good in two, fair in two and poor in one patient.
Ilzarov's Technique for Treatment of Madelung's Deformity by Lengthening and Re-Axation of the Distal Extremity of the Radius
Naseer Ahmed Mir,Altaf Ahmed Kawoosa, G.R.Mir
JK Science : Journal of Medical Education & Research , 2003,
Abstract: Seven children (12 to 15 years) having madelung's deformity were considered for the study. All thechildren complained ofaesthetic deformity with functional difficulties with their daily life activities.Ilizarov's technique by lengthening and re-axation of distal extremity of the radius was used astherapeutic modality. The short term follow up provides satisfactory results. However. long termstudy is needed to say with certainty that the technique prevent ubsequent secondary osteo anlu-itis.
Minimally Invasive Surgery for Pectus Excavatum: Park Technique
Hyung Park
Journal of Clinical and Analytical Medicine , 2011, DOI: 10.4328
Abstract: Pectus excavatum (PE) is the most commonly encountered chest wall deformity which comprises one out of 1,000 live births. Depression of the anterior chest wall due to posterior angulation of the sternum and costal cartilages results in compression of internal thoracic organs as well as aesthetically unpleasant appearance. Multiple surgical techniques have been developed to correct this condition. Ravitch procedure, the technique including the excision of all deformed costal cartilages, division of intercostals bundles from the sternum, and transverse sternal osteotomy, was proposed in 1949 and most widely applied until recently. The Wada technique, principally sternal turnover, has been an alternative procedure. Those invasive techniques involve tedious and bloody operations resulted in a permanent defect of costal cartilages or contracture of the chest wall. Most importantly, a large, unsightly operative scar at the anterior chest is aesthetically dissatisfying. In this study “Minimally Invasive Surgery for Pectus Excavatum: Park Technique” was explained.
Bone lengthening osteogenesis, a combination of intramembranous and endochondral ossification: an experimental study in sheep
Francisco Forriol,Luca Denaro,Umile Giuseppe Longo,Hirofumi Taira,Nicola Maffulli,Vincenzo Denaro
Strategies in Trauma and Limb Reconstruction , 2010, DOI: 10.1007/s11751-010-0083-y
Abstract: We evaluated the morphological features of the newly formed tissue in an experimental model of tibial callotasis lengthening on 24 lambs, aged from 2 to 3 months at the time of operation. A unilateral external fixator prototype Monotube Triax (Stryker Howmedica Osteonics, New Jersey) was applied to the left tibia. A percutaneous osteotomy was performed in a minimally traumatic manner using a chisel. Lengthening was started 7 days after surgery and was continued to 30 mm. The 24 animals were randomly divided into three groups of 8 animals each: in Group 1, lengthening took place at a rate of 1 mm/day for 30 days; in Group 2, at a rate of 2 mm/day for 15 days; in Group 3, at a rate of 3 mm/day for 10 days. In each group, 4 animals were killed 2 weeks after end of lengthening, and the other 4 animals at 4 weeks after end of lengthening. To assess bony formation in the distraction area, radiographs were taken every 2 weeks from the day of surgery. To study the process of vascularization, we used Spalteholz’s technique. After killing, the tibia of each animal was harvested, and sections were stained with hematoxylin and eosin, Masson’s trichrome, and Safranin-O. Immunohistochemistry was performed, using specific antibodies to detect collagens I and II, S100 protein, and fibronectin. A combination of intramembranous and endochondral ossification occurred together at the site of distraction. Our study provides a detailed structural characterization of the newly formed tissue in an experimental model of tibial lengthening in sheep and may be useful for further investigations on callotasis.
Minimally invasive scoliosis surgery: an innovative technique in patients with adolescent idiopathic scoliosis
Vishal Sarwahi, Adam L Wollowick, Etan P Sugarman, Jonathan J Horn, Melanie Gambassi, Terry D Amaral
Scoliosis , 2011, DOI: 10.1186/1748-7161-6-16
Abstract: Minimally invasive spine surgery is becoming more common for the treatment of multilevel pathology, including adult lumbar degenerative disorders [1-3]. The next logical step is to apply minimally invasive surgical techniques to the treatment of adolescent idiopathic scoliosis (AIS). However, there are significant technical challenges of performing minimally invasive surgery on this patient population. In contrast to adult degenerative scoliosis, the curves in AIS patients are much larger (usually 45-50° or more), the number of levels instrumented are longer (7-13), the deformity exists in three planes, and the vertebral rotation can be significant. Placement of pedicle screws (14-26 screws) also increases radiation exposure for both the patient and the surgeon [4-6]. In patients with double major curves, passing a rod that is contoured in the normal sagittal profile (thoracic kyphosis and lumbar lordosis) is a challenge in and of itself.The ultimate goal of the surgical management of AIS is to obtain an adequate fusion. In contrast to the adult population, an anterior approach is often not utilized in AIS patients, either for release or for fusion [7]. Thus, it is imperative that any surgical technique for AIS allows for adequate fusion at the facet joint. In the context of minimally invasive surgery, obtaining sufficient surface area for arthrodesis can be challenging. Bone morphogenic protein can be utilized, but is an off-label indication for this age group as well as for this type of surgery.Two other important issues in considering minimally invasive approaches to AIS are the length and type of skin incision as well as the reduction maneuvers employed for deformity correction. The standard stab incision for placement of minimally invasive or percutaneous pedicle screws cannot be utilized in adolescent patients, as fourteen to twenty six stab incisions in the back can be quite disconcerting for a young patient. Additionally, surgeons treating large spinal defor
Nasal tip narrowing: Minimally invasive suture technique for thick nose tip
Nassif Filho, Antonio Celso Nunes,Romano, Giovana,Ribas, Denise Braga,Sass, Scheila Maria Gambeta
International Archives of Otorhinolaryngology , 2011,
Abstract: Introduction: Suture techniques are mandatory methods to shape the nasal cartilages. For purposes of achieving a better contour on thick or globose nasal tips, the authors have approached a controlled intercrural and minimally invasive suture technique and the results obtained by submitting 34 patients to rhinoplasty. Objective: Illustrate the intercrural suture technique as a treatment for a thick or globose nasal tip under closed rhinoplasty and explain the esthetical results. Method: Retrospective study with 34 patients' clinical documents and photographs (5 male and 20 female) aged between 16 and 52, who were submitted to the thick or globose nasal tip rhinoplasty as an anatomic element found in the physical examination. In all the cases, closed rhinoplasty technique was used. A suture that cannot be absorbed is performed throughout the intermediate process. The study was performed at the Brazilian Red Cross Hospital in the State of Paraná and Sugisawa Hospital in 2009 and 2010. Patients were operated on by the main author and the junior doctors under training. Results: The controlled intercrural suture enabled the nasal tip to be narrowed and improved the shape in the frontal and lateral angles of the nasal tip. Conclusion: Controlled intercrural suture is a minimally invasive method providing the thick nasal tip narrowing with satisfactory results.
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