肢体延长长度的临床观察与实验研究

肢体延长中为防损害组织的结构与功能,普遍以组织弹性允许限度为原则,一般均主张将延长度控制在骨原长度10～15％。为安全达到大幅度延长,本文报道在牢稳固定骨断端和早期功能锻炼条件下,用每日1～1.25mm缓慢速度延长法,观察骨骺牵伸延长80例和干骺端截骨延长63例,延长率为骨原长度9～84.3％,其中16例达到30～84.3％。绝对延长数达6～16cm者有69例,其中1例同时延长胫骨与股骨,一期(131天)矫正下肢22cm巨大短缩。实验组15只山羊小腿延长率为骨原长度28.6～64.8％(平均50.2％)。无一例并发神经与血管损伤或骨不连。作者对本组结果提出不同于组织弹性限度的新认识,认为神经、血管与骨膜等组织对缓慢的逐渐延长有相当大的生物学适应能力,低牵张力能刺激肢体组织同步增殖生长,从而避免损害组织结构及其功能。

CLINICAL OBSERVATION AND EXPERIMENTAL STUDY ON EXTREMITY LENGTHENING

When an extremity is being lengthened, the principle of the elasticity limitation of living tissues is always considered to be a guide fo avoid injuries to the nerves, blood vessels and periostium. It is generally believed that the lengthening should not exceed 10~15% of the original length of the bone. In order to attain a safe and large scale lengthening of a limb, the authors, under the condition of secure fixation of bone ends and early functional excercise of the diseased limb by using a specially des-gned external fixator, adopted a gradual lengthening with a slow speed of 1~1.25mm/d.Eighty cases of epiphysial distraction and 63 cases of metaphyseal osteotomy to lengthen extremities were studied. It was found that the expected lengthening in all the cases was achieved with a lengthening rate of 9~84.3% of the original length. It was 30~84.3% in 16 cases. The absolute lengthening was 6~16 cm in 69 cases. In one case, the femur and tibia were elongated at the same time, and a large shortening of 22 cm of the right lower limb was corrected in a one-stage operation (131 days).Experiments were performed on 15 goats. The lengthening rate of the tibia was 28.6~64.8% of the original length, with an average of 50.2%. In both the clinical and experimental studies, no nerve or blood vessel injury or non-union of the bone was found.The authors proposed a new concept different from the principle of elasticity limitation of livingissues. It is believed that nerves, blood vessels and periostium possess good adaptation capacity to slowand gradual lengthening. Low tension from traction can stimulate the tissues of the extremity to grow synchronously with the slow gradual lengthening and no injury will be inflicted to the structures and functions of the tissues concerned.