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Khirurgii

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Year 2016 Vol. 24 No 4

TRAUMATOLOGY & ORTHOPEDICS

D.A. POPKOV, A.V. POPKOV, V.A. SHCHUROV, N.A. KONONOVICH

FUNCTIONAL RECOVERY AFTER OPERATIVE LOWER LIMB LENGTHENING AT HIGH-DIVISION REGIME IN CHILDREN

FSBE " Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics", of the RF Ministry of Health,
Kurgan
The Russian Federation

Objectives. To study the features of the functional rehabilitation of children with congenital and acquired shortenings of the lower limbs after surgical lengthening using different regimes of distraction osteosynthesis.
Methods. Treatment results of children (n=95) with congenital and acquired lower limb shortening by the Ilizarov method for distraction osteosynthesis been analyzed. The distraction regime: group 1 (n=27, mean age 9,9±4,1 yrs) – 1mm a day (n=4); group 2 (n=30, mean age 10,1±1,9 yrs) 1mm a day (n=60) in the automated regime; group 3 (n=38, mean age 11,5±2,3 yrs) – a distraction regime 1 mm a day (n=60) in an automated regime combined with intramedullary reinforcement by elastic wires with hydroxyapatite coating. After removing the Ilizarov device the restoration of normal knee and ankle joint function, the dynamics of the antagonist muscles forces and onset time walking without additional support have been assessed.
Results. It was shown that at femoral lengthening by using a robotic high-division distractor with using intramedullary reinforcement with bioactive coating, the earlier restoration of active and passive amplitude of motions in the adjacent joints, segment muscle force and complete limb axial load had occured. Such effects could be associated with both the favorable conditions for regeneration of bone and muscle tissues at high-division rate as well as with the possibility of the earlier full functional load after the removal of the Ilizarov apparatus and leaving intramedullary implants in site.
Conclusion. Thus, the combination of robotic high-division distraction (24 h) and intramedullary bioactive reinforcement creates favorable conditions for a rehabilitation process and a faster functional recovery.

Keywords: robotic automated distractor, limb lengthening, bioactive implants, intramedullary implants, regeneration, muscular system, functional rehabilitation
p. 373-378 of the original issue
References
  1. Sokolovskii OA, Serdiuchenko SN, Brodko GA, Ur'ev GA. Uravnivanie dliny nizhnikh konechnostei – istoricheskie rakursy i sovremennye tendentsii [Equalization of the length of the lower extremities - historical perspectives and current trends]. Med Novosti. 2011;(7):11-19.
  2. Sabharwal S, Green S, McCarthy J, Hamdy RC. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am. 2011;93:213-221. doi: 10.2106/JBJS.J.01420.
  3. Dinah AF. Predicting duration of Ilizarov frame treatment for tibial lengthening. Bone. 2004 May;34(5):845-48.
  4. Matsubara H, Tsuchiya H, Sakurakichi K, Watanabe K, Tomita K. Deformity correction and lengthening of lower legs with an external fixator. Int Orthop. 2006 Dec; 30(6): 550-54. doi: 10.1007/s00264-006-0133-8.
  5. Sun XT, Easwar TR, Manesh S, Ryu JH, Song SH, Kim SJ, et al. Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail: a case-matched comparative study. J Bone Joint Surg Br. 2011 Jun;93(6):782-87. doi: 10.1302/0301-620X.93B6.25521.
  6. Kim SJ, Balce GC, Agashe MV, Song SH, Song HR. Is bilateral lower limb lengthening appropriate for achondroplasia? Midterm analysis of the complications and quality of life. Clin Orthop Relat Res. 2012 Feb;470(2):616-21. doi: 10.1007/s11999-011-1983-y.
  7. Ur'ev GA, Il'iasevich IA, Zarovskaia AV, Sokolovskii OA, Iuzefovich AI. Izmenenie funktsional'nogo sostoianiia nervno-myshechnoi i sosudistoi sistem ukorochennykh konechnostei v usloviiakh distraktsionnogo osteosinteza [Changing of the functional state of neuromuscular and cardiovascular systems of shortened limbs in conditions of distraction osteosynthesis]. Med Zhurn. 2008;(2):97-100.
  8. Alzahrani MM, Anam EA, Makhdom AM, Villemure I, Hamdy RC. The effect of altering the mechanical loading environment on the expression of bone regenerating molecules in cases of distraction osteogenesis. Front Endocrinol (Lausanne). 2014 Dec 10;5:214. doi: 10.3389/fendo.2014.00214.
  9. Shchurov VA, Dolganova TI, Dolganov DV. Ustanovka dlia izmereniia sily myshts bedra [A device for measuring of the thigh muscles strength]. Med Tekhnika. 2014;(1):27-30.
  10. Bhave A, Shabtai L, Ong PH, Standard SC, Paley D, Herzenberg JE. Custom knee device for knee contractures after internal femoral lengthening. Orthopedics. 2015 Jul 1;38(7):e567-72. doi: 10.3928/01477447-20150701-53.
  11. Burghardt RD, Manzotti A, Bhave A, Paley D, Herzenberg JE. Tibial lengthening over intramedullary nails: A matched case comparison with Ilizarov tibial lengthening. Bone Joint Res. 2016 Jan;5(1):1-10. doi: 10.1302/2046-3758.51.2000577.
  12. Prince DE, Herzenberg JE, Standard SC, Paley D. Lengthening with external fixation is effective in congenital femoral deficiency. Clin Orthop Relat Res. 2015 Oct;473(10):3261-71. doi: 10.1007/s11999-015-4461-0.
  13. Radler C, Antonietti G, Ganger R, Grill F. Recurrence of axial malalignment after surgical correction in congenital femoral deficiency and fibular hemimelia. Int Orthop. 2011 Nov;35(11):1683-8. doi: 10.1007/s00264-011-1266-y.
  14. Dal Monte A, Donzelli O. Tibial lengthening according to Ilizarov in congenital hypoplasia of the leg. J Pediatr Orthop. 1987 Mar-Apr;7(2):135-38.
  15. Popkov AV, Popkov DA. Osobennosti funktsional'nogo vosstanovleniia posle operativnogo lecheniia detei s vrozhdennym ukorocheniem nizhnikh konechnostei [Features of functional recovery after surgical treatment of children with congenital shortening of the lower limb]. Genii Ortopedii. 2008;(1):19-26.
Address for correspondence:
640014, Russian Federation, Kurgan, M. Ulyanova st., 6,
FGBI "Russian Scientific Center" Restorative Traumatology and Orthopaedics" named by Academician GA Ilizarov", laboratory of limb lengthening and correction of deformity in the lower limbs.
Tel: 7 (3522) 41-52-27
E-mail: n.a.kononovich@mail.ru
Kononovich Natalya Andreevna
Information about the authors:
Popkov D.A. MD, Head, FSBE "Russian Ilizarov Center for Restorative Traumatology and Orthopedics", laboratory of limb lengthening and correction of deformity in the lower limbs.
Popkov A.V. MD, Professor, Chief researcher,
FSBE "Russian Ilizarov Center for Restorative Traumatology and Orthopedics", laboratory of limb lengthening and correction of deformity in the lower limbs.
Shchurov V.A. MD, Professor, Chief researcher,
FSBE "Russian Ilizarov Center for Restorative Traumatology and Orthopedics", laboratory of limb lengthening and correction of deformity in the lower limbs.
Kononovich N.A. PhD, Leading researcher,
FSBE "Russian Ilizarov Center for Restorative Traumatology and Orthopedics",laboratory of limb lengthening and correction of deformity in the lower limbs.
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