什么是肢体差异？
肢体长度的差异是一条腿或手臂比另一只腿或手臂短。长度的差异可以从一英寸到几英寸的范围。有些孩子天生congenital limb differencesthat cause their legs or arms to grow at different rates. Other limb-length discrepancies are caused by seriousfractures, a fracture that does not heal properly, a bone infection such asosteomyelitis, or骨肿瘤或囊肿.
Compared to differing arm lengths,leg-length discrepancies更有可能影响孩子的日常活动。两种不同长度的腿要求孩子改变正常的姿势和步行方式。根据差异程度，腿长差异可能导致各种问题，例如功能scoliosis, and hip, knee, and ankle problems.
有温和的孩子arm-length discrepanciesoften adapt well to the difference. However, a difference in arm length of two to three inches or more can interfere with activities of daily life and should be addressed.
Types of limb-length discrepancies
- Structural discrepancy – a bone in one leg or arm is shorter than the same bone in the other limb.
- 功能差异 - 腿或手臂的骨长相等，但是膝盖，臀部，肩膀，肘部或其他关节的关节缔合（低关节迁移率）从四肢中的对称性扔下。
肢体长度差异的症状是什么？
The symptoms of a limb-length discrepancy vary widely from child to child based on whether a leg or arm is affected, the degree of difference in length, and the cause of the condition.
Some common symptoms include:
- one leg or arm is shorter than the other (this is not always obvious)
Signs of leg-length discrepancy
- 姿势问题，例如倾斜肩膀
- walking problems, such as limping or toe-walking
- 长期在短侧延伸并在长边弯曲的膝盖
- pain in the back, hip, knee, or ankle
Additional signs of arm-length discrepancy
- difficulty reaching both handlebars on a bike
- difficulty holding the steering wheel of a car with both hands
- difficulty sitting in or standing up from a chair with arm rests
What causes limb-length discrepancies?
Congenital (present at birth) limb-length discrepancies develop during pregnancy. Others are caused by illness or trauma.
Congenital limb-length discrepancies
- 当腿或手臂中的一个或多个长骨在怀孕期间没有完全发育时，有些孩子天生就有肢体长度的差异。在大多数情况下，没有已知的原因。
- Some leg-length discrepancies occur when a child is born with a problem that changes the alignment of their hips, such as coxa vara or developmental dislocation of the hip.
Injury or illness-related limb length discrepancies
- A complex fracture or a fracture that does not heal properly can slow the growth of the affected bone. Some fractures can also lead to overgrowth of bone during the healing process. This is most common in thighbone (femur) injuries.
- Damage to the growth plate through injury or a bone infection such as osteomyelitis can affect growth. Growth plates are soft areas at each end of the long bones in the arms and legs where bone growth takes place. When a teen or young adult reaches adult height, the growth plates harden into solid bone. If the growth plate in one limb is damaged, the other limb will continue to grow and a difference in length will develop over time.
- 骨肿瘤和骨囊肿会阻断骨骼的生长。根据肿瘤或囊肿的位置和大小，通过手术去除，辐射, orchemotherapymay cause the bone to grow more slowly or stop growing altogether.
- Cerebral palsy其他神经肌肉问题可能会导致儿童对齐和整体姿势的问题，这可能导致肢体长度的差异。
How we care for limb-length discrepancies
TheLimb-Lengthening and Reconstruction Programat Boston Children’s Hospital provides comprehensive care for children and young adults with leg or arm differences that are present at birth or caused by injury or illness. Our team, which draws on experts from both ourLower Extremity Program和Hand and Orthopedic Upper Extremity Program, has deep expertise in both non-surgical care and limb-lengthening and reconstruction procedures.
我们的临床医生已经治疗了数千名婴儿，儿童和年轻人的状况，范围从常规到高度复杂的肢体差异。我们还提供波士顿儿童提供的广泛服务以及世界上一些最先进的临床和科学研究的好处。
We’ll work with you and your child to review the available options and decide the best course of treatment based on your child’s individual needs.
肢体长度差异|诊断和治疗
How is a limb-length discrepancy diagnosed?
The first step in diagnosing a limb-length discrepancy is a complete medical history and physical examination by an orthopedic surgeon. During the exam, the doctor will measure your child's limbs to calculate how different they are in length.
如果您的孩子的腿长差异，医生可能会看着您的孩子走路，以寻找他们正在弥补不同腿部长度的迹象。他们的医生还可以要求您的孩子站在较短的腿下站立，以衡量将臀部和其余身体保持一致所需的矫正量。
Your child’s doctor may also order anX射线or other imaging tests for a more precise measurement of the discrepancy.
How are limb-length discrepancies treated?
肢体长度差异可以通过几种不同的方式处理。有些治疗涉及手术，而另一些疗法则没有。您的孩子的骨科外科医生将与您讨论孩子的选择：
- your child's age, overall health, and medical history
- the limbs affected (leg or arm)
- the amount of discrepancy
- 您孩子对特定药物，程序或疗法的容忍度
- your and your child’s expectations and preferences
一些均衡肢体长度的治疗方法简单安全。尤其是其他人肢体延长手术,是复杂的,有患并发症的风险。
Non-surgical treatments for leg-length discrepancy
Several non-surgical treatments may help improve function, especially if your child has a mild length discrepancy (less than one inch for a leg; less than two inches for an arm).
- A鞋升inside the shoe of your child’s shorter leg can level out the difference in leg lengths. A shoe lift may help your child walk and run with greater ease and reduce back pain.
- Physical therapyincludes special stretches and exercises that can help reduce pain and increase overall function.
- 职业治疗focuses on developing your child’s fine motor skills, such as handwriting.
- Adaptive devicescan help your child with everyday activities, such as tying their shoes, buttoning their shirt, and holding a book.
- Prostheticscan be designed to fit over a short limb. They can also replace all or part of a limb that has been amputated.
Surgical treatments for limb-length discrepancy
Leg-shortening surgery
If your child’s leg-length discrepancy is expected to be moderate (between two and six centimeters) when your child reaches adult height, their surgeon may recommend shortening the longer leg. Shortening procedures slow growth of the longer leg so the shorter leg can catch up. This is generally safer and results in fewer complications than limb-lengthening surgery. Your child will be slightly shorter at adult height than they would be without leg-shortening surgery.
- epiphystiesis是针对尚未成长的孩子进行的。外科医生暂时或永久地融合生长板，以防止长肢生长。时间安排很重要，以避免腿的长度过度校正。
- 顿悟钉uses staples that are surgically inserted on each side of the growth plate. Once the legs are of equal length, the staples are removed.
- Bone resectioninvolves removing a section of bone in the longer leg. This can be performed on adults or adolescents who have reached their adult height.
Limb-lengthening surgery
肢体延长手术刺激较短的腿或手臂的新骨生长。肢体延长仅对具有干扰日常生活活动的肢体长度差异的患者进行。通常，当患者在十几岁或成年初期时进行。
Lengthening surgeries take several months and may need to be repeated, depending on your child’s stage of growth and the extent of their limb-length difference.
- In the first stage of limb lengthening, an orthopedic surgeon cuts the bone to be lengthened (a procedure called an osteotomy). They then attach a lengthening device that your child will wear for several months. The types of lengthening devices are described in greater detail below.
- Over the next several months, you or your child will adjust the device every day to increase the gap between the two ends of bone. This will stimulate the body’s natural healing process to create new bone to fill in the space.
- While the lengthening is taking place, your child will need to have regular visits with their orthopedic surgeon to ensure the lengthening is going smoothly and address any possible complications before they become serious.
肢体延长设备的类型
肢体延长设备有两种类型。一种类型的戴在手臂或腿的外部。另一个是一种更精确的内部装置，可降低并发症和感染的风险。
External fixatorsare worn on the outside of the limb and are attached to the bone by pins. The patient or family adjusts the device daily to increase the distance between the two ends of bone. Once the correct length is reached, the device remains on the leg or arm while the new bone hardens and becomes strong. The device is then surgically removed.
Theinternal fixator (PRECICE Nail)is a nail that is surgically inserted inside the bone after the osteotomy. Using an external magnet that causes the nail to expand, the patient or family slowly lengthens the bone a tiny amount each day until the desired length is reached. Like the external fixator, the internal fixator is removed once the limb has been lengthened and new bone has formed.
左肱骨：A。在延长之前；B.最初使用预钉约4.5厘米后一年；C.第二次延长〜4.5厘米后立即；D.第二次延长六个月后。