Is the Intramedullary Skeletal Kinetic Distractor a Safe Measure for Bone Lengthening? A Systematic Review: 用ISKD髓內骨骼延長釘來進行骨骼延長是一個安全方法嗎？一個系統性回顧

BackgroundThe intramedullary skeletal kinetic distractor (ISKD) is one of the relatively recent methods developed to overcome the complications of conventional bone lengthening methods, such as external fixators. These complications include pain, muscle transfixation, pin-tract infection, reduced joint motion, and prolonged fixation time. However, ISKD-specific complications such as uncontrollable lengthening and hardware failure make the outcomes of ISKD lengthening questionable. In this article, we review published literature on the efficacy and complications of the ISKD device.MethodsA database search was conducted in PubMed, Ovid Medline, Ovid Full Text, Springer link, EBSCO Medline, Science Direct, ISI Web of Knowledge, and Google Scholar. We included English articles with extractable data about the study population and outcomes, reporting ISKD implantation in the femur or tibia of skeletally mature patients. The included studies were too heterogeneous for a meta-analysis to be performed.ResultsFifteen of 89 potentially relevant citations were found to match the inclusion criteria. The most common causes of limb-length discrepancy indicating an ISKD implantation were traumatic and congenital. The average lengthening achieved, average patient discharge period, mean follow-up time, average consolidation time and index, average distraction time and index, and number of patients requiring additional operations as well as other outcome measures are discussed in this article. The most common complications were runaway nail, difficulty in achieving lengthening, and poor bone regenerate formation.ConclusionEven though the classic complications of external lengthening are virtually diminished, alterations to the current design of the ISKD are needed to avoid the distraction- related complications. Risk of unplanned surgery could be minimized through proper patient selection and proper surgical techniques.

中 文 摘 要背景：髓內骨骼延長釘（ISKD）是為了克服常規骨骼延長的方法，如外固定支架，的併發症而新近發展的技術。常規骨骼延長方法的併發症包括疼痛，肌肉釘住，針道感染，減少關節運動和長期的固定時間。然而，ISKD 特有的併發症，如無法控制的延長和硬件故障都令人懷疑ISKD的療效。在本文中，我們將回顧已發表關於ISKD療效和併發症的文獻。方法：在PubMed，Ovid Medline， Ovid Full Text和Springer link，EBSCO Medline，Science Direct，ISI Web of Knowledge和谷歌Scholar 的數據庫搜索。我們包括那些可以取得研究群組和結果數據，並報告了在骨骼成熟的病人身上把 ISKD植入股骨或脛骨的英語文章。結果：在89個相關的文章中有15個符合納入標準，當中最常見的手術原因是先天性疾病和創傷。在本文中討論我們討論了平均延長距離，患者平均住院時間，平均隨訪時間，平均骨愈合時間和指數，平均延長的時間和指標，需要接受額外手術的患者的數量等。最常見的併發症是延長釘出位，難以達到延長目標和骨不愈合。結論：儘管使用ISKD使到外固定支架的典型併發症幾乎消失，目前ISKD的設計仍然需要改動，以避免延長時出現的併發症。無計劃的手術風險可以通過適當的患者選擇和正確的手術方法來最減少。