背景:经骨牵张接骨术在软骨发育不全儿童的骨科护理中被优先考虑。然而,治疗和康复过程中遇到的困难直接影响患者的生活质量。与轮辐圆形装置相比,在半圆形框架内使用杆状外部固定器进行接骨术的创伤较小。他们的直接组装和安装在肢体段可以帮助显著减少治疗持续时间,从而提高儿童在治疗和康复期间的生活质量。
目的:本研究旨在对生活质量进行比较分析(通过术后疼痛综合征来衡量,身体活动,和情绪状态)在患有软骨发育不全的儿童中,使用具有改良的分散控制的外部固定器或作者开发的圆形多轴系统进行成对肢体延长。
方法:这是一个观察性的,prospective,非随机化,纵向研究与历史控制。研究组由14名5至15岁(平均7.6,SD2.3)的患者组成,经遗传证实诊断为软骨发育不全。所有患者都接受了配对的肢体延长,并使用了棒外固定器和作者开发的改良的分散控制。总共28个肢体段,其中4(14%)肱骨,8(29%)股骨,和16(57%)胫骨,在1轮中加长。先前研究的未发表数据作为对照组,包括9名相同年龄段的患者(18个肢体段)(手术时的平均年龄8.6,SD2.3岁),使用圆形多轴系统2(11%)肱骨进行肢体延长手术,6(33%)股骨,和10个(56%)胫骨。Wong-Baker面孔评定量表用于测量疼痛症状,而Russified儿科生活质量(PedsQL)v4.0问卷评估了生活质量。
结果:在潜伏期(手术后7至10天),在对照组中,PedsQLv4.0问卷中的身体活动和情绪状态指标出现了更明显的下降(根据儿童及其父母的反应,平均值52.4,SD4.8与平均值52.8,SD5.5分,分别)与实验组(根据儿童的反应及其父母的反应,平均值59.5,SD6.8分和平均值61.33,SD6.5分,分别)。两组之间的差异具有统计学意义(儿童的反应P<0.05,父母的反应P<0.01)。重要的是,手术后6个月,这些生活质量指标,根据实验组儿童的报告,平均70.25(SS4.8)点。同样,其父母报告的平均值为70.54(SD4.2)分.在对照组中,相应的值分别为69.64(SD5.6)和69.35(SD6.2),分别。组间无统计学意义差异。
结论:作者开发的具有改良的牵引控制的外固定器在潜伏期阶段与圆形多轴系统相比提供了更高的生活水平。
BACKGROUND: Transosseous distraction osteosynthesis is prioritized in orthopedic care for children with
achondroplasia. However, difficulties encountered during treatment and rehabilitation directly impact patients\' quality of life. Using rod external fixators within a semicircular frame for osteosynthesis is less traumatic compared to spoke circular devices. Their straightforward assembly and mounting on the limb segment can help significantly reduce treatment duration, thereby improving children\'s quality of life during treatment and rehabilitation.
OBJECTIVE: This study aimed to conduct a comparative analysis of the quality of life (measured by postoperative pain syndrome, physical activity, and emotional state) among children with
achondroplasia undergoing paired limb lengthening using either an external fixator with modified distraction control or a circular multiaxial system developed by the authors.
METHODS: This was an observational, prospective, nonrandomized, and longitudinal
study with historical control. The study group consisted of 14 patients ranging from 5 to 15 (mean 7.6, SD 2.3) years old with a genetically confirmed diagnosis of
achondroplasia. All patients underwent paired limb lengthening with a rod external fixator and a modified distraction control developed by the authors. A total of 28 limb segments, among them 4 (14%) humeri, 8 (29%) femurs, and 16 (57%) tibias, were lengthened in 1 round. Unpublished data from the previous
study served as the control group, comprising 9 patients (18 limb segments) of the same age group (mean age at surgery 8.6, SD 2.3 years), who underwent limb lengthening surgery using a circular multiaxial system-2 (11%) humeri, 6 (33%) femurs, and 10 (56%) tibias. The Wong-Baker Faces Rating Scale was used to measure pain symptoms, while the Russified Pediatric Quality of Life (PedsQL) v4.0 questionnaire assessed quality of life.
RESULTS: During the latent phase (7 to 10 days after surgery), a more pronounced decrease in the indicators of physical activity and emotional state on the PedsQL v4.0 questionnaire was noted in the control group (mean 52.4, SD 4.8 versus mean 52.8, SD 5.5 points according to children\'s responses and their parents\' responses, respectively) compared to the experimental group (mean 59.5, SD 6.8 points and mean 61.33, SD 6.5 points according to the children\'s responses and their parents\' responses, respectively). The differences between the groups were statistically significant (P<.05 for children\'s responses and P<.01 for parents\' responses). Importantly, 6 months after surgery, these quality-of-life indicators, as reported by children in the experimental group, averaged 70.25 (SS 4.8) points. Similarly, their parents reported a mean of 70.54 (SD 4.2) points. In the control group, the corresponding values were 69.64 (SD 5.6) and 69.35 (SD 6.2), respectively. There was no statistically significant difference between the groups.
CONCLUSIONS: The external fixator with modified distraction control developed by the authors provides a higher standard of living compared with the circular multiaxial system during the latency phase.