Resum
Objectius Mostrar resultats, complicacions i lliçons apreses utilitzant el clau intramedul·lar magnètic (IML , Intramedullary Magnetic Lengthener) en un grup de pacients sotmesos a allargament ossi.
pacients i Mètodes entre gener 2017 i desembre 2019, 9 pacients (15 segments), edat entre 15 i 39 anys, van ser sotmesos a allargament ossi amb IML: 5 pacients van tenir allargament femoral bilateral per talla baixa, 1 pacient es va sotmetre a allargament de Cames bilateral per Tèbia vara i escurçament mesomélico i 3 van rebre allargaments femorals unilaterals per discrepància de longitud d’extremitats. Tots van ser operats pel mateix cirurgià, amb tècnica standard. Es va indicar cinesiteràpia a l’almenys 5 vegades per setmana durant la fase de distracció.
Resultats En tots es va aconseguir l’objectiu d’allargament plantejat. No hi va haver complicacions intra ni postoperatòries greus (TVP, TEP, Embòlia grassa), ni falles de sistema distractor. Un pacient va desenvolupar contractures articulars de dos genolls per no adhesió a Cinesiteràpia. Cap va requerir aportació d’empelt ossi, però en 2 pacients d’allargament de Fèmur bilateral, es va presentar deformitat en var, que va fer necessari recanvi a clau convencional i un pacient va desenvolupar una paràlisi transitòria de l’Nervi Peroneal comú.
conclusions l’adveniment dels IML va significar un gran avenç en el camp de la osteogènesi per distracció, però, encara es tracta d’un procediment complex, que ha de ser planificat acuradament per minimitzar els riscos i complicacions. Una selecció meticulosa de l’pacient i l’avaluació física i psicològica prèvia, són fonamentals per a l’èxit de l’procediment. Els casos bilaterals requereixen d’un seguiment proper, pel risc de falla de l’implant.
Abstract
Objective We show our results, Complications and lessons learned using the Intramedullary Magnetic Lengthener (IML) in a group of patients who were subjected to bone lengthening.
Patients and Methods Between January 2017 and December 2019, 9 patients (15 segments), aged between 15 and 39 years, underwent bone lengthening with IML: 5 patients had bilateral femoral lengthening due to short Stature, 1 patient had bilateral leg lengthening due to Tibia vara and mesomelic shortening and 3 had unilateral femoral lengthening for limb length discrepancy. All were operated by the same surgeon, with standard technique. Physical therapy was indicated at least 5 times per week during the Distraction phase.
Resultats In every casi, the proposed lengthening amount was achieved. There were no serious intraoperative or postoperative Complications (DVT, Pulmonary Embolism, Fat Embolism), nor failures of the distractor system. One patient developed knee aliança d’contracture due to non-adherence to Physical therapy. None required bone grafting, however, in 2 patients with bilateral Femur, a varus deformity appeared, which required nail exchange with a conventional trauma nail. One casi developed a transit common peroneal Nerve palsy.
Conclusions IMLs va representar a great advance in the bone lengthening realm, however, it is still a complex procedure, which must be carefully planned to minimize risks and Complications. Meticulous patient selection and prior physical and psychological evaluation are essential to the success of the procedure. Bilateral cases need a closer follow up, because implant failure is a potential risk.
Paraules clau
allargament ossi – osteogènesi per distracció – clau intramedular magnètic
Keywords
bone lengthening – Distraction osteogènesi – magnetic intramedullary nail
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Publication History
Received: 13 April 2020 a Accepted: 19 June 2020
Dades de la publicació: de 10 August 2020 (en línia)
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