骨段撑开转移治疗骨缺损国外进展

Advance on the bone transport distraction osteogenesis for the treatment of bone defects

节段性骨缺损是下肢开放性骨折中较严重的损伤,传统的治疗包括:采用外固定支架稳定骨折、应用游离组织移植修复软组织缺损创面以及用带血管或不带血管的骨移植修复骨缺损。骨段撑开转移是治疗骨缺损的一种新方法,适宜治疗3～12cm的骨干缺损,仅需行少量松质骨移植以促进局部骨愈合。而常规治疗方法植骨量较大,因而,供骨区并发症较少。而且,不需行游离组织移植修复创面。缺点是相对复杂,治疗时间长。当病例选择适当以及对技术掌握完善时,对某些骨缺损病例的治疗,才能充分发挥其优越性。

Segmental bone defects are very severe in open fractures of the lower extremity. Traditional treatment requires skeletal stabilization, usually by external fixation, followed by free tissue transfer for soft tissue coverage, and vascularized or nonvascularized bone grafting for the skeletal defect. The bone transport distraction osteogenesis is a new method for treating bone defects. The range of bone loss for which bone transport is indicated 3 to 12 cm. The method required only small bone grafts to stimulate healing at the bone defect site, whereas patients in the conventionally treated group needed a larger volume of cancellous bone graft. Donor site morbidity was less in the method, and no free-tissue transfers were required. Disadvantages of the method was a complex, time-consuming reconstruction. In the appropriately selected patient, when the surgeon is experi- enced in the technique, treatment by bone transport distraction osteogenesis offers unique advantages for certain cases of the bone defect.