Problems of lengthening of the lower limbs in children and stimulation of reparative processes in the area of distraction regenerates

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Abstract

During the period from 1988 to 2000 the compensation lower limb shortening was performed in 285 patients, aged 2.5-18 years, at CITO Pediatric Orthopaedic Clinik. In 5 patients with severe extremity malformation and severe vascular pathology surgical interventions aimed at facilitation of subsequent prosthesis and orthesis. The other patients were subjected to surgical correction using rod distraction device of original design. Complex rehabilitation treatment including functional biocontrol was started in the early postoperative period. The condition of distraction regenerate was evaluated by X-ray, CT and Doppler Laser Flowmetry data. In 63 patients with congenital lower extremity pathology in whom insufficient regeneration was observed the implants containing fetal bone tissue were inserted into the regenerate zone resulting in marked osteogenic effect. Suggested treatment allowed to improve the outcomes and shorten the terms of treatment.

 

About the authors

O. A. Malakhov

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Moscow

O. V. Kozhevnikov

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

N. P. Omelianenko

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

A. A. Belyaeva

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

A. I. Krupatkin

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

I. S. Kosovo

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com

 

 

Russian Federation, Moscow

References

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2. Rice. 1. Patient M., 5 years old. Diagnosis: malformation of the right lower limb (class 3), shortening 23 cm. a — appearance at admission; b — absence of the proximal femur, abduction-flexion contracture; c — aplasia of the deep femoral artery, hypoplasia of the femoral artery, absence of collaterals; d — iliofemoral arthrodesis on the right with fixation with pins (King's operation), knee joint in place of the hip joint; e — 3 months after King's operation: the patient is wearing an orthopedic apparatus.

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3. Rice. 2. Patient V., 12 years old. Diagnosis: congenital shortening of the lower leg by 6 cm, pelvic tilt, lateroposition of the patella, impaired posture. a - appearance at admission; b — an osteotomy of the lower leg was performed, a rod distraction apparatus was applied; c — in the process of elongation; d — after 5 months: radiologically mature bone regenerate; e — on computed tomograms, the cortical layer and the medullary canal are restored, there are no violations of the integrity of the bone tube, however, the thickness of the cortical layer is 60% of that on the opposite side.

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4. Рис. 3. Рентгенограммы больной К. 5 лет. Диагноз: аномалия развития правого бедра (класс 8), укорочение конечности на 6 см (а). Произведена остеотомия правого бедра с наложением стержневого дистракционного аппарата, в зону остеотомии уложен гомогенат ЭКТ (б). Через 2 мес — повторное пункционное введение ЭКТ. Аппарат демонтирован через 5,5 мес после операции: состояние регенерата удовлетворительное (в).

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5. Rice. 4. Structure of distraction regenerates (scanning electron microscopy). a — before ECT application: loose, disoriented collagen fibers (magnitude 1000); b — 5 weeks after implantation of ECT: a growth zone and a zone of active bone formation are clearly identified, which in turn has zoning according to the maturity of bone structures (magnitude 100).

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6. Rice. 5. Radiographs and angiogram of patient G., 8 years old. Diagnosis: congenital shortening of the right lower leg by 6 cm.a - Before surgery (angiogram shows hypoplasia of the vascular network of the lower leg); b — 2 months after the operation: weakness of the distraction regenerate. A bioactive polymer "straw" with EKT lyophilizate was introduced into the area of the regenerate by puncture; c — 6 months after the operation.

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7. Rice. 6. Training with biofeedback according to EMG.

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