髂骨再塑形治疗股骨大段缺损新概念

NEW CONCEPT FOR THE MANAGEMENT OF LARGE BONE DEFECT OF FEMUR SHAFT BY USING ILIAC BONE RESHAPING

目的探索合理利用髂骨皮质骨和松质骨的新方法,将髂骨按股骨的解剖形态进行再塑形修复股骨大段骨缺损的可行性。方法按股骨缺损的解剖形态制模,按照宽=1/2股骨周长、长=股骨缺损段的长度取髂骨块,经内、外板间剖开髂骨块,在圆柱体上将内、外板卷制成拱状(有微骨折,但仍保持连续),将拱状骨皮质面向模具内壁,剖开面向模具轴芯装入模具内,拱状骨与模具轴芯间填塞松质骨,将模具包埋于髂骨取骨处,克氏针固定模具。结果髂骨可再塑形为带空腔的管状骨,解剖形态与股骨一致。结论利用模具可将髂骨按预期骨的解剖形态进行再塑形,塑形骨可治疗大段骨缺损,为大段骨缺损的治疗提供了新思路、新概念。

Objective To investigate a new method of reasonable using the cortical and cancellous of iliac bone,and an available method for the management of large bone defect of femur shaft by iliac bone reshaping performed in a model according to anatomy morphology of the expected bone of segmental femur shaft. Methods A model was made according to anatomy morphology of the expected bone of large defect of femur shaft. A bony block of iliac bone was taken out according to the calculated width and length. The width is half of the circumference of the large bone defect. The length equals to the length of the bone defect. The iliac block was split between the outer and inner plate. On the surface of cylinder, the outer and inner plate of the iliac block were rolled into arch respectively. Microfracture within the bone was performed successively. To control the cortical surface towards the internal wall of the model and the dissected surface towards the axis of the model, the arch bone was encased in the model. The cancellous bone was impacted into the cavity between the arch bone and the axis of the model. The model with the impacted bone was implanted in the iliac region and fixed with Kirseher wire at the remained iliac crest. Results The iliac bone reshaping can be performed in the prefabricated model. The anatorriy morphology of the reshaped bone is identical with the large bone defect of femur shaft. The reshaped bone can be implanted in the region of bone defect for the management of large bone defect of femur shaft. Conclusion According tO the anatomy morphology of the expected bone,lilac bone can be reshaped by using the prefabricated model. Treatment of bone defect by using the reshaped bone may offer a new concept for the management of the large bone defect.