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Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia

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World Journal of Clinical Cases 2022年第24期10卷 8482-8489页

作者： Maryam Salimi Rojin Sarallah Salar Javanshir Seyed Peyman Mirghaderi Amirhossein Salimi Shokoufeh Khanzadeh Department of Orthopaedic Surgery Shiraz University of Medical SciencesShiraz 71936-13311Iran Department of Medicine Islamic Azad University Medical Branch of TehranTehran 713843809Iran Students'Scientific Research Center Tehran University of Medical SciencesTehran ***Iran Department of Medicine Shahid Sadoughi University of Medical SciencesYazd ***Iran Student Research Committee Tabriz Sadoughi University of Medical SciencesTabriz 716534908Iran

There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side *** tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound *** contractures are typically a consequence of the generated tension on the distracted *** can be managed by physiotherapy initially and surgically in later severe ***,it is essential to avoid muscle contracture development,which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following *** knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony *** stiffness is the other possible unfavorable effect of *** happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of *** and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint ***,the effect of mental and physical rehabilitation programs should not be overlooked.

关键词： Fibular hemimelia Rehabilitation Reconstruction lengthening

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Benefits of Ilizarov automated bone distraction for nerves and articular cartilage in experimental leg lengthening

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World Journal of Orthopedics 2017年第9期8卷 688-696页

作者： Nathalia Shchudlo Tatyana Varsegova Tatyana Stupina Michael Shchudlo Marat Saifutdinov Andrey Yemanov Laboratory of Morphology FSBI Russian Ilizarov Scientific Center "Restorative Traumatology and Orthopaedics"

AIM To determine peculiarities of tissue responses to manual and automated Ilizarov bone distraction in nerves and articular *** Twenty-nine dogs were divided in two experimental groups: Group M-leg lengthening with manual distraction(1 mm/d in 4 steps), Group A-automated distraction(1 mm/d in 60 steps) and intact group. Animals were euthanized at the end of distraction, at 30 th day of fixation in apparatus and 30 d after the fixator removal. M-responses in gastrocnemius and tibialis anterior muscles were recorded, numerical histology of peronealand tibialis nerves and knee cartilage semi-thin sections, scanning electron microscopy and X-ray electron probe microanalysis were *** Better restoration of M-response amplitudes in leg muscles was noted in A-group. Fibrosis of epineurium with adipocytes loss in peroneal nerve, subperineurial edema and fibrosis of endoneurium in some fascicles of both nerves were noted only in M-group, shares of nerve fibers with atrophic and degenerative changes were bigger in M-group than in A-group. At the end of experiment morphometric parameters of nerve fibers in peroneal nerve were comparable with intact nerve only in A-group. Quantitative parameters of articular cartilage(thickness, volumetric densities of chondrocytes, percentages of isogenic clusters and empty cellular lacunas, contents of sulfur and calcium) were badly changed in M-group and less changed in *** Automated Ilizarov distraction is more safe method of orthopedic leg lengthening than manual distraction in points of nervous fibers survival and articular cartilage arthrotic changes.

关键词： Limb lengthening Articular cartilage Nerve Histomorphometry Dog

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Femoral lengthening in young patients:An evidence-based comparison between motorized lengthening nails and external fixation

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World Journal of Orthopedics 2021年第11期12卷 909-919页

作者： Mohamed Hafez Nicolas Nicolaou Amaka C Offiah Stephen Giles Sanjeev Madan James A Fernandes Department of Oncology and Metabolism Sheffield UniversitySheffield S102TNUnited Kingdom Department of Paedaiatric Limb Reconstruction Sheffield Children HospitalSheffield S102THUnited Kingdom Department of Radiology Sheffield Children HospitalSheffield S102THUnited Kingdom Department of Trauma and Orthopaedics Sheffield Children HospitalSheffield S102ThUnited Kingdom

BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb *** advances have led to the latest designs of fully implantable motorized intramedullary lengthening *** use of these nails has increased over the last few *** To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external *** Electronic databases(MEDLINE,CINAHL,EMBASE,Cochrane)were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external *** outcomes included amount of gained length,healing index,complications and patient reported *** Of the 452 identified studies,only two(retrospective and non-randomized)met the inclusion criteria.A total of 91 femora were *** both studies,the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation *** devices achieved the target *** of adverse events was less in the nail(60%-73%)than in the external fixation(81%-100%)*** of the studies presented patient reported *** The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young *** available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.

关键词： lengthening nails Motorized nails Distraction ostepgenesis lengthening

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Effect of lengthening along the anatomical axis of the femur and its clinical impact

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World Journal of Orthopedics 2017年第5期8卷 431-435页

作者： Khaled M Emara Ahmed Nageeb Mahmoud Ahmed K Emara Mariam K Emara Limb Reconstruction and Deformity Correction Unit Orthopaedic Surgery Department Ain Shams University Hospitals

AIM To review and study the effect of lengthening along the anatomical axis of long bones and its relation to the mechanical axis *** We try in this review to calculate and discuss the exact clinical impact of lengthening along the anatomical axis of the femur on affecting the limb alignment. Also we used a trigonometric formula to predict the change of the femoral distal anatomical mechanical angle(AMA) after lengthening along the anatomical axis. RESULTS lengthening along the anatomical axis of the femur by 10% of its original length results in reduction in the distal femoral AMA by 0.57 degrees. There is no objective experimental scientific data to prove that the Mechanical axis is passing via the center of the hip to the center of the knee. There is wide variation in normal anatomical axis for different populations. In deformity correction, surgeons try to reproduce the normal usual bone shape to regain normal function, which is mainly anatomical axis. CONCLUSION lengthening of the femur along its anatomical axis results in mild reduction of the distal femoral AMA. This may partially compensate for the expected mechanical axis lateralisation and hence justify its minimal clinical impact.

关键词： Bone lengthening Deformity Femoral lengthening External fixation Intramedullary nail Axis deviation

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An animal experiment on short gut lengthening

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Chinese Medical Journal 1997年第5期 34-37页

作者：陈亚军张金哲曲瑞瑶王计晨谢贻祥

Objective To investigate the anatomical and histological changes of the lengthened gut by a special intraluminal tubular expander on the basis of the theory of “tension stress”. Methods Nineteen New Zealand white rabbits were used. A 5 cm segment of the terminal ileum with a pedicle was put underneath the abdominal wall, with its proximal end closed and its distal end exteriorized as a stoma. One week later, as the wound healed well, an expander made of a small rubber tube was inserted into the short gut loop through the stoma. Three milliliters of water was injected as an initial dose. Then 0.5 ml water as an increment was injected subsequently every 12 hours until the total amount of water reached 15 ml and kept stable for two weeks. Results Anatomically, the length and the capacity of the intestinal loop were recorded, after 15 ml expanding, as an average of 150% lengthening of the original and an average of 293% expansion. Two weeks after the removal of the expander, partial shrinking was observed. A stable lengthening had 123% of the original length, while the capacity reduced to 200% of the original one. Histologically, there was no remarkable changes of the mucosa or submucosa. But significant hypertrophy of the musculature and serosa layer was observed. The total thickness of the musculatures was 618% of the normal control's. Ultrastructurally,there were enlargement of the smooth muscle cells, increase in number and size of the mitochondria in the cytoplasm and widening of the intercellular space. Conclusion A short gut can be lengthened by a tubular expander following the rule of gradual tension and stress.

关键词：张金哲 An animal experiment gut lengthening short 陈亚军曲瑞

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The Load-Displacement Curves of Deep Fascia in Response to Tension Stress Principle during Limb lengthening: a Preliminary Study

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Chinese Journal of Biomedical Engineering(English Edition) 2000年第4期9卷 141-148页

作者： WANG Hai qiang 1,Huang Yao tian 1,ZHAO Li 1,CAI Hua 2,GAO Hong 1 1 Institute of Orthopedics,Xijing Hospital, Fourth Military Medical University,Xian 710032,China 2 Department of Pediatrics, Xijing Hospital, Fourth Military Medical Univers

Objective:To investigate the load displacement curves of deep fascia of leg in response to the Tension Stress principle during limb lengthening. Methods:Limb lengthening animal model was established in New Zealand white rabbits using a unilateral external fixator applied with four pins to the medial surface of tibia and monofocal proximal diaphysis with closed multiple drill holes and osteoclasis between the second and the third *** days after operation,distraction was initiated at distraction rates of 1mm/day and 2mm/day in two steps,and proceeded until increases of 10% and 20% in the initial length of tibia had been *** fascia samples of 30mm×10mm were clamped with the Instron 1122 tensile test device at room temperature with the constant tensile rate of 5mm/*** 5 load download tensile tests had been performed,the samples were elongated until *** the load displacement curves were automatically generated. Results:The normal fascias showed typical load displacement rule of collagenous *** each experimental group of fascias kept the *** curves of fascias at a rate of 1mm/day were closer to the curves of normal *** the normal fascias,the ultimate tension strength was avarage 2.69N,and the strain at rupture was avarage 14.11%.And the ultimate tension strength of the fascias after limb lengthening increased. Conclusion:These results prove that the Tension Stress during limb lengthening has great effect upon the load displacement curves of *** curves of fascia at a distraction rate of 1mm/day were closer to the curves of normal fascia.

关键词： limb lengthening Tension Stress principle fascia stress mechanical

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A Therapeutic Concept by “Watted” for the Surgical lengthening of the Lower Face by Short Face Syndrome

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Open Journal of Stomatology 2015年第5期5卷 127-141页

作者： Nezar Watted Abu-Hussein Muhamad Josip Bill Peter Proff Department of Orthodontics Arab American University Jenin Palestine Department of Pediatric Dentistry University of Athens Athens Greece Clinic for Cranio-Maxillo-Facial Surgery Würzburg Germany Department of Orthodontics University of Regensburg Regensburg Germany

The continuously growing esthetic awareness for the facial appearance and the spreading of information about the possibilities of adult treatment by public media result in an increase of adult patients which seek orthodontic treatment to improve their facial esthetics. In general, these patients show such a severe skeletal deformity that it is detectable even by non-experts because of its extraoral manifestation, which is the main motivation for treatment. Because of the nature of these deformities and because of the lacking growth usable for therapy the only promising treatment for these patients is the combined orthodontic-surgical approach. Besides a stable and functional occlusion with physiologic position of the condyle, the goals of treatment are the improvement of the dental and, above all, facial esthetics since the patient judges the success of treatment mostly by the extraoral appearance. The dentofacial appearance must be defined prior to treatment to plan the individual right approach in knowledge of the different treatment possibilities for Angle Class II deformities and thus be able to reach for both sides—patient and orthodontist—satisfying result. With this article, a systematic therapy concept to treat patients with Class II deformities and skeletal deep bite with a short lower face (short face syndrome) under consideration of the soft tissue analysis is presented.

关键词： Cephalometrics Facial Proportions Lower Face Height Skeletal Deep Bite Short Face Syndrome lengthening of the Lower Face Bilateral Sagittal Split Osteotomy Mandibular Advancement Splint Therapy Lateral Open Bite

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Histological changes after tibial lengthening with metaphyseal osteotomy in goats

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Journal of Medical Colleges of PLA(China) 1993年第1期8卷 60-64页

作者：胡建曾宪政李起鸿柳凤轩 Departments of Orthopedics Clinical Pathology~2 Southwest HospitalThird Military Medical College Chongqing 630038

The histological changes after tibial lengthening with metaphyseal osteotomywere observed in 30 *** was found that(1)a slow lengthening rate of 1 mm/d couldenable the tissues to adapt the mechanical traction and consequently increase thelengthening limitation;(2)the newly-formed bone in the lengthened area might be due to acombined osteogenesis of endochondral,intramembranous,and fibrous tissue ossification;and(3)the osteogenetic process could be distinguished into 3 stages as hemorrhage andorganization of the hematocele,callus formation,and remodelling of the newly-formedbones.

关键词： tibia bone lengthening animal goats

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Effects of duration of type 2 diabetes mellitus on lengthening and enlargement of small abdominal aortic aneursym

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World Journal of Cardiovascular Diseases 2013年第6期3卷 401-405页

作者： Shijun Li Jianguo Wang Tingshu Yang Geriatric Cardiology of Chinese PLA General Hospital Beijing China

Objective: The purpose of our study aimed at evaluating the relationship of type 2 diabetes with longitudinal extension of AAA. Methods: All of 460 AAA patients aged from 41 to 92 years were retrospected in our study, and they were at least twice admitted into our hospital from January 2000 to April 2010. All patients received ultrasound measurement of aorta during each admission. Results: Our results indicated that changes of length of AAA were significantly greater in patients with diabetes than those in patients without diabetes. Type 2 diabetes was associated with length extension of AAA. In subgroup analysis, type 2 diabetes was only related to length change of small AAA rather than large AAA. Diabetes was not an independent risk factor for length extension of small AAA. There was no significant difference of glycosy-lated hemoglobin between diabetes patients and nondiabetes patients. Conclusions: Type 2 diabetes mellitus is closely related to length growth of small AAA, whereas diabetes is not an independent risk factor for length extension of small AAA, and serum glucose under better control could not bring about better result in limiting length extension of small AAA.

关键词： Diabetes lengthening Small Abdominal Aortic Aneurysm

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Electrophysiological observation on tibial nerve during and after limblengthening in rabbits

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Journal of Medical Colleges of PLA(China) 2000年第3期15卷 192-195页

作者：范少地许建中钟桂午李起鸿吴宗耀

Objective: To observe the subclinical damage and natural repairing process of the tibial nerve during and after limb lengthening with slow stretching in 10 rabbits. Methods: The tibia of Japanese rabbits was lengthened by 4O%. Before, during and in the following 8 weeks after the limb elongation, the compound sensory evoked potential (CSEP) of posterior tibial nerves in both hind limbs was recorded with electrophysiological instrument. The histological changes were observed under light and electron microscope . Results: During limb lengthening, significant changes in the latent period, peak value and area of the CSEP were fond. The latent period recovered by 50% ac 65% respectively in 2th and 4th week after the tibia being lengthened by 40%. An the 3 parameters of the CSEP, were restored up to 95% as the control in 8th week after elongation and the histological damages also recovered at the same time. Conclusion: The subclinical damage of the peripheral nerve during limb lengthening is temporary and convertible with Ilizarov’s [1] gradual limb lengthening method .

关键词： limb lengthening peripheral nerve rabbits

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