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Factors influencing bone regenerate healing in distraction osteogenesis.
[achondroplasia]
The
dynamics
and
effectiveness
of
new
bone
formation
in
the
Ilizarov
method
varies
according
to
different
factors
.
Some
of
them
may
result
in
substantial
prolongation
of
treatment
time
.
The
lengthening
index
(
LI
)
,
defined
as
the
number
of
months
in
a
frame
necessary
to
achieve
1
cm
lengthening
,
is
the
main
indicator
of
bone
healing
potential
.
The
purpose
of
the
study
was
to
assess
the
effectiveness
of
distraction
osteogenesis
by
analysing
the
lengthening
index
(
LI
)
in
relation
to
:
age
,
limb
length
discrepancy
,
aetiology
,
bone
segment
involved
,
axial
correction
and
lengthening
achieved
.
We
studied
251
patients
between
the
ages
of
3
to
50
years
(
mean
15
.
3
)
treated
with
the
Ilizarov
method
because
of
lower
limb
inequality
.
A
total
of
319
lengthening
procedures
were
analyzed
(
tibia--
155
,
femur--
164
)
.
Total
treatment
time
(
time
in
a
frame
)
and
magnitude
of
lengthening
were
recorded
in
all
patients
to
calculate
LI
(
months
per
1
cm
of
lengthening
)
.
Patients
were
divided
into
several
groups
according
to
these
factors
.
Mean
LI
in
the
entire
sample
was
1
.
6
months
/
cm
(
from
0
.
7
to
5
.
9
)
.
The
lowest
LI
(
1
.
4
)
was
recorded
in
the
youngest
patients
(
from
3
to
9
years
)
and
increased
with
age
,
amounting
to
1
.
6
in
the
10
-
17
years
'
age
group
,
1
.
7
in
the
18
-
21
years
'
age
group
and
2
.
4
in
the
22
-
50
years
'
age
group
.
The
mean
LI
for
femoral
lengthening
was
lower
(
1
.
5
)
than
for
the
tibias
(
1
.
8
)
.
In
a
group
of
63
cases
of
lengthening
up
to
4
cm
,
LI
was
2
.
3
;
in
another
group
(
from
4
to
7
cm
-
189
procedures
)
LI
was
lower
(
1
.
6
)
,
and
in
the
last
group
(
more
than
7
cm
)
it
was
1
.
2
.
There
was
no
significant
difference
in
mean
LI
between
the
groups
with
and
without
axial
correction
.
However
,
differences
between
aetiology
groups
were
statistically
significant
,
with
a
mean
LI
of
1
.
2
in
achondroplasia
patients
,
1
.
4
in
post-septic
patients
and
patients
with
and
Ollier
disease
,
1
.
6
in
patients
with
congenital
deformities
,
1
.
8
in
post-traumatic
patients
and
2
.
0
in
neurogenic
and
clubfoot
patients
.
According
to
the
lengthening
index
analysis
,
the
effectiveness
of
distraction
osteogenesis
is
related
to
age
,
aetiology
,
bone
segment
involved
and
the
magnitude
of
lengthening
,
while
it
is
not
related
to
axial
correction
.
Diseases
Validation
Diseases presenting
"bone segment"
symptom
achondroplasia
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