一期延长矫正下肢26cm巨大短缩畸形和骨不连的远期效果

Treatment of bone nonunion and lower extremity great shortening deformity of 26 cm by primary bone lengthening with a long-time follow-up

目的 总结一期延长矫正下肢 2 6cm巨大短缩畸形同时治愈骨不连的经验。方法 患者 10岁女孩 ,右股骨短缩 15cm ,同时合并骨不连 ,右胫骨短缩 11cm ,采用股骨粗隆下截骨与胫骨上干骺端截骨、缓慢牵伸逐渐延长肢体 ,同时加压外固定治疗骨不连。术后 5d开始延长 ,1 5mm/2次 /日。结果 经 2 2 3d延长股骨 15cm ,胫骨 11cm ,骨不连同时治愈。未发生神经、血管损伤。术后 9个月X线片显示右股骨及胫骨延长区连续性新骨生长好 ,骨不连愈合 ,13个月两个骨延长区骨性愈合 ,拆除外固定架扶拐行走。 14个月延长区骨髓腔形成 ,术后 18月上学读书。远期信访右肢骨、胫骨延长区域和骨不连处未再发生骨折 ,生活基本自理。结论 本例治疗成功关键因素是截骨延长部位合理设计 ,牵伸延长速度缓慢和骨断端牢稳固定。

Objective To summarize the long term outcome of the treatment of nonunion and great shortening deformity of 26 cm of lower extremity by primary bone lengthening. Methods A 10 years old girl with right femoral shaft nonunion and shortening of 15 cm, tibia shortening of 11 cm were treated with external fixator, and a subtrochanter and tibia metaphyseal osteotomy was made before gradual lengthening, the nonunion was treated by compression. The lengthening began 5 d after operation, twice a day and 1.5 mm daily. Results Femoral lengthening of 15 cm and tibial lengthening of 11 cm was achieved after 223 d, the nonunion was cured. No neurovascular complications happened. X ray showed good new bone formation after 9 months in the nonunion area, the bony healing occurred in the lengthening area after 13 months, the external fixator was removed and the patient could walk by using a walking stick. Intramedullary canal was formed after 14 months, and she went back to school after 18 months. During 1 year follow up by letter, no re fracture occurred in the lengthening area and nonunion site, and the patient could take care of herself. Conclusion The key point in this case is the sound design of the osteotomy, gradual lengthening and stable fixation of the fracture.