The doctor’s point of view on the increase in height.
The question of the ratio of individual dimensions of the human body, its height and proportions has long attracted the attention of anthropologists and anatomists, which was reflected in the works of Leonardo da Vinci, Gaia, Zeising, Stratz, Vorobyov V.P., Bunak V.V. Despite the large number of works devoted to the study of normal heights and proportions of the human body, there is currently a lack of modern and accessible information in this area.
Nevertheless, knowledge of the boundaries of the variability of growth and proportions of the human body in various groups (social, professional, ethnic, racial, etc.) is of great importance for applied and theoretical anthropology and practical medicine. Of great importance for orthopedic cosmetology is the accuracy of measuring the main anthropometric parameters, since the tactics of the treatment is based on this. To correct the height of a person, it is necessary to accurately determine the values of a number of the most important long-range indicators.
The height or length of a person is one of the common anthropometric signs that is included in the indicator of a person’s physical development. Multiple attempts to increase the height in adults with the help of various medications, sets of exercises were unsuccessful, because after stopping natural growth there is no point of application for their impact – zones of physiological growth of the bone. Therefore, the only possible way to allow adults to become taller is surgical lengthening of the lower extremities .
Until the middle of the 20th century, various types of osteotomies were used to lengthen the limbs: transverse, Z-shaped, oblique, stepped, etc. The actual lengthening was carried out either simultaneously in the operating room, or gradually, using skeletal traction with increasing weights. However, the method of one-stage lengthening has not become widespread due to the high trauma, insignificant lengthening and frequent severe complications. It should be added that the maximum elongation did not exceed 10% of the segment length. Skeletal traction could not prevent the displacement of fragments in different planes under the influence of muscle tone.
Currently, for limb lengthening, most surgeons prefer to use distraction devices, which, in contrast to skeletal traction, provide dosed constant stretching of the fragments. Distraction devices are divided into implantable (on-osseous osteosynthesis, intramedullary osteosynthesis) and extrafocal distraction devices (transosseous osteosynthesis, Ilizarov apparatus).
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The most well-known implantable distraction device in our country is the Bliskunov device (1992), which provides rigid fixation of the bone fragments of the femur during femoral lengthening , allows gradual and dosed stretching of the bone fragments while maintaining their precise orientation and centering along the axis. In this case, the force developing in the apparatus acts directly on the bone fragments.
The developed method of intramedullary distraction, according to the authors, completely excludes the use of external devices, drives and sources of forces located outside the patient’s body, can be used to lengthen the limbsin patients. However, the use of implantable devices is quite traumatic, significantly impairs bone regeneration, impairs intraosseous blood supply and prevents endosteal bone formation.
In addition, the need for repeated operations to remove devices from the bone marrow canal is also a negative aspect of the application of this technique. According to many authors, in Russia, the method of choice for surgical limb lengthening has recently become the method of G.A. Ilizarov.
Works by G.S. Dzhanakhishova and other authors prove that surgical lengthening of the lower extremities according to Ilizarov creates optimal conditions for reparative regeneration of elongated tissues, expressed in reliable fixation of bone fragments, low trauma of surgical intervention, full blood supply to the elongated segment of the extremity, a rational pace of distraction, the possibility of functional loads on the extremity and joints.
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In addition, the use of transosseous osteosynthesis allows, simultaneously with limb lengthening, if necessary, correction of bone deformities, as well as modeling the shape of the limb, and is the method of choice for treating patients with shortening and various limb deformities.
According to the literature, the best object for lower limb lengthening is the lower leg, since complications associated with the use of external fixation devices on the thigh are much more common than with lower limb lengthening , and range from 20-78.8%. Research data by A.I. Reutova (1990) and others showed that with a one-stage increase to 25% of the original length,
it is characterized by active osteogenesis and reversible changes in the muscles of the lower leg. Further elongation (up to 50%) leads to the death of muscle tissue, a sharp increase in intermuscular connective tissue, and a decrease in the activity of bone formation even in conditions of maintaining intraosseous blood supply before the onset of distraction.
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The main problems that arise during the lengthening of the lower limbs are the limitations of soft tissue extensibility and, as a result, the limitation of movements in the joints adjacent to the segment being lengthened. In this regard, it is necessary to pay special attention to the procedures aimed at increasing the extensibility of tissues and the mobility of adjacent joints of the operated limb segment.
The requirements of cosmeticity and safety are fundamental when carrying out surgical increase in growth for cosmetic purposes. Therefore, when lengthening the lower limbs in orthopedic cosmetology, minimally traumatic technologies should be used with the exception of additional surgical interventions. The versatility of the design and sufficient stability of fixation of bone fragments, the possibility of various layouts and modifications make the Ilizarov apparatus the basic design in orthopedic cosmetology.
From the above, the following conclusions can be drawn:
• To increase growth in an adult is possible only by surgery.
• It is necessary to use distraction devices to lengthen the lower extremities.
• Surgical lengthening of the lower limbs according to Ilizarov creates optimal conditions for reparative regeneration of lengthened tissues.
• Distraction ( elongation ) should take place evenly at a rate of 1 mm/day to the optimal value.
• With a one-stage lengthening , the optimal amount of distraction is about 25% of the original leg length.
