genortГений ортопедииGenij Ortopedii1028-44272542-131XЦЕНТР ИЛИЗАРОВА10.18019/1028-4427-2024-30-2-301-308RPAGRVgenort-2969Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWЭволюция тактических подходов в устранении неравенства длины нижних конечностейEvolution of tactical approaches to eliminating limb length discrepancyНовиковК. И.NovikovK. I.

Константин Игорьевич Новиков — доктор медицинских наук, профессор, врач травматолог-ортопед, ведущий научный сотрудник

Курган

Тюмень

Konstantin I. Novikov — Doctor of Medical Sciences, Professor, traumatologist-orthopedist, leading researcher

Kurgan

Tyumen

kinovikov@mail.ruКомароваЭ. С.KomarovaE. S.

Элина Сергеевна Комарова — врач травматолог-ортопед, врач эксперт, руководитель филиала

Курган

Elina S. Komarova — traumatologist-orthopedist, expert doctor, head of the branch

Kurgan

КолесниковС. В.KolesnikovS. V.

Сергей Владимирович Колесников — врач травматолог-ортопед

Курган

Sergei V. Kolesnikov — traumatologist-orthopedist

Kurgan

КлимовО. В.KlimovO. V.

Олег Владимирович Климов — доктор медицинских наук, врач травматолог-ортопед

Курган

Oleg V. Klimov — Doctor of Medical Sciences, traumatologist-orthopedist

Kurgan

СергеевК. С.SergeevK. S.

Константин Сергеевич Сергеев — доктор медицинских наук, профессор, заведующий кафедрой

Тюмень

Konstantin S. Sergeev — Doctor of Medical Sciences, Professor, Head of the Department

Tyumen

Национальный медицинский исследовательский центр травматологии и ортопедии имени академика Г.А. Илизарова; Тюменский государственный медицинский университетРоссияIlizarov National Medical Research Centre for Traumatology and Orthopedics; Tyumen State Medical UniversityRussian FederationГлавное бюро медико-социальной экспертизы по Курганской областиРоссияMain Bureau of Medico-Social Expertise in the Kurgan RegionRussian FederationНациональный медицинский исследовательский центр травматологии и ортопедии имени академика Г.А. ИлизароваРоссияIlizarov National Medical Research Centre for Traumatology and OrthopedicsRussian FederationТюменский государственный медицинский университетРоссияTyumen State Medical UniversityRussian Federation202428042024302301308Copyright © Новиков К.И., Комарова Э.С., Колесников С.В., Климов О.В., Сергеев К.С., 20242024Новиков К.И., Комарова Э.С., Колесников С.В., Климов О.В., Сергеев К.С.Novikov K.I., Komarova E.S., Kolesnikov S.V., Klimov O.V., Sergeev K.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ilizarov-journal.com/jour/article/view/2969Введение

Введение. Проблема устранения неравенства длины нижних конечностей (англ. Limb Length Discrepancy — LLD) актуальна и имеет высокую медицинскую и социальную значимость. LLD является серьезным физическим недостатком, который причиняет страдания больному, изменяет его походку, формирует патологические приспособительные механизмы, а у детей самым отрицательным образом влияет на формирование опорно-двигательной системы.

Цель работы — проанализировать эволюцию тактических подходов к реабилитации пациентов с неравенством длины нижних конечностей.

Материалы и методы

Материалы и методы. Выполнен поиск релевантных научных публикаций на русском и английском языках на электронных платформах PubMed и eLibrary по запросам: lower limbs, length inequality, methods and means of length correction, osteosynthesis, неравенство длины нижних конечностей, подходы и средства коррекция длины конечностей, остеосинтез. Для анализа отобраны клинические руководства, клинические рекомендации, систематические обзоры, рандомизированные контролируемые исследования, мультицентровые когортные исследования.

Результаты и обсуждение

Результаты и обсуждение. У практически здоровых людей часто встречается разница в длине нижних от нескольких мм до 1,5 см, что никак не отражается на походке и состоянии смежных суставов и суставов противоположной конечности. Некоторые авторы считают, что неравенство всего в 5 мм может привести к ортопедической патологии. Для выравнивания длины конечностей ортопеды предлагают различные консервативные и оперативные методики. Устранение LLD — это распространенная и до конца нерешенная медицинская проблема. Консервативное лечение LLD может рассматриваться как один из этапов реабилитации, так как, несмотря на разработанные средства консервативного лечения LLD, их применение не приводит к должному результату, и приоритетом в решении этой проблемы является оперативное лечение.

Заключение

Заключение. Предложенные ранее методики оперативного лечения LLD имели недостатки, которые в итоге свели к минимуму их использование, а от некоторых ортопеды отказались ввиду высокого риска развития тяжелых осложнений. Разработанный в 50-х годах прошлого века аппарат, а затем и методика доктора Илизарова явились эпохальным событием в устранении LLD и постоянно продолжают свое совершенствование.

Introduction Limb length discrepancy (LLD) can be debilitating and may cause other medical and social problems. LLD is a serious physical condition and have a significant impact on the patient's quality of life changing the gait, forming pathological adaptive mechanisms and causing long-term musculoskeletal disturbances in children. The objective was to analyze the evolution of tactical approaches to the rehabilitation of patients with lower limb length inequality.

Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru) and the National Library of Medicine (www.pubmed.org). Literature searches included both Russian and English studies. The search strategy was comprised of keywords: lower limbs, limb length inequality, approaches and means of limb length correction, osteosynthesis. Clinical guidelines, clinical recommendations, systematic reviews, randomized controlled trials and multicenter cohort studies were selected for analysis.

Results and discussion Normal individuals can often experience a difference in the length of the lower limbs from several mm to 1.5 cm and have no effect on the gait, condition of adjacent joints and joints of the opposite limb. Some authors report inequality of 5 mm leading to orthopaedic pathology. A variety of  conservative and  surgical treatments are offered for limb length equalization. Elimination of LLD is a  common and  unresolved medical problem. Conservative treatment of LLD can be considered as one of  the  stages of rehabilitation. Some patients can benefit from conservative treatments. Alternatively, surgical equalization is a treatment option for patients with LLD.

Conclusion Surgical methods offered earlier to address LLD had disadvantages, which ultimately minimized their use, and orthopaedic surgeons abandoned some of them due to the high risk of severe complications. The device and the technique developed by Dr. Ilizarov in the 50s of the last century was an epoch-making event in the elimination of LLD and are constantly being improved.

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The authors declare that there are no conflicts of interest present.