单边外固定架骨段滑移术治疗部分骨缺损

Management of partial bone defect by a bone transport method using unilateral external fixator

目的探索使用单边外固定架骨段滑移术治疗部分骨缺损的可行性。方法回顾性分析2008年12月至2009年7月治疗的3例部分骨缺损患者的病例，男2例，女1例；年龄分别为50、50、24岁。左胫骨近段内侧骨缺损2例，其中1例骨缺损长5cm，宽占该区直径1／3-2／3，合并宽5cm、长3cm皮肤缺损；另1例骨缺损，长6cm，宽3cm；1例右股骨远段外侧骨缺损，长13am，宽占全部周径的1／3-2／3，骨面为贴骨瘢痕，长15cm，宽7cm。彻底清创后，安装Orthofix公司肢体重建系统；自胫骨缺损远侧缘起向远侧，沿胫骨前方取-10cm长纵行切口，采用多孔技术行截骨术。术后第14天开始牵拉骨质，速度为1mm／d，4次/d。结果3例患者随访时间分别为14、28、24个月。2例胫骨缺损患者分别在截骨术后8个月和6个月影像学检查示新生骨形成良好，被滑移骨段与宿主骨愈合，故去除外固定架，患侧髋、膝和踝关节活动范围同健侧。股骨缺损患者截骨术后因调错牵开器方向，骨段滑移术不成功；2个月后再次实施截骨及骨段滑移术，术后10个月新生骨形成良好，拆除外固定架；术后17个月患者可独自站立和持手杖行走，膝关节僵直于中立位，无感染及复发。结论使用单边外固定架行骨段滑移术可治疗部分骨缺损；该方法具有肢体畸形发生率低，外固定架带架时间短及避免供区损伤等优点。

Objective To evaluate the effect of a bone transport method using unilateral external fix- ator in treatment of partial bone defect. Methods Three patients with partial bone defect were reviewed, in- cluding 2 males and 1 female, and whose ages were 50, 50, and 24 years, respectively. The defects were at medial part of the left proximal tibia in 2 cases. In the first case, the defect was 5 cm in length, 1/3-2/3 of transverse diameter in width, with a 5 cmx3 cm skin loss. In the second case, the defect was 6 em in length and 3 cm in width. For the remaining patient, the bone defect was located in lateral part of the right femur, which was 13 cm in length, 1/3-2/3 of transverse diameter in width, with a 15 crux7 cm scar on it. After de- bridement of the wound, the Orthofix＇s limb reconstruction external fixation system was mounted medially, initially with 2-3 HA coated screws in the middle clamp to anchor the near cortex of the segment to be transferred. A partial eorticotomy was performed with multiple drill hole technique. The gradual segment transport was started 2 weeks after the operation at a rate of 1 ram/d, 4 times/d. Results The follow-up time was 14, 28 and 24 months, respectively. The external fixator was removed 8 and 6 months after the osteotomy in 2 patients, when radiographs demonstrated bony union of the docking site as well as mature consolidation of the generated callus. The range of motion of hip, knee, ankle on the injured side was similar to the unin- jured side. The segment was unable to be transported successfully in the femur, because the compression- distraction device was misused. Two months after the first operation, the osteotomy was performed at the same site for the second time. The frame was removed at 10 months after the second osteotomy when the new bone formed well and the fracture healed at the docking site. The patient was able to stand independently and walk with a stick at 17 months after the osteotomy. At the latest follow-up, there was no sign of osteomyelitis. Conclusion Bone transport method using unilateral external fixator is a practical option to treat partial bone defect. In addition to shorten the period with fixator, it can avoid malunion and donor injury.