Orthofix单边外固定架在骨肿瘤外科治疗中的应用

Application of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors

目的探讨Orthofix单边外固定架在骨肿瘤外科治疗中的应用特点及初步临床效果。方法回顾分析2011年6月—2016年3月因原发良、恶性骨肿瘤接受外科治疗并应用Orthofix单边外固定架的22例患者临床资料。男11例,女11例;年龄4~57岁,中位年龄23.5岁。肿瘤切除后骨缺损或肢体短缩部位:股骨上段6例,股骨下段8例,股骨中段3例,胫骨上段2例,胫骨中段3例。外固定架应用情况:骨缺损重建后临时固定10例(骨缺损长度6~19 cm,平均12.3 cm;采用带血管蒂腓骨移植2例,同种异体骨+游离腓骨移植2例,同种异体骨+自体骨移植5例,同种异体骨重建1例);肢体短缩行骨延长5例(短缩长度6.5~8.5 cm,平均7.5 cm);3例术前活检无法明确诊断,行切开活检,为预防病理骨折临时采用外固定架固定;肿瘤切除后骨缺损应用骨搬运1例(骨缺损长度7.5 cm);病理骨折术前化疗临时固定1例;股骨远端骨肉瘤行海扶刀治疗后,膝关节严重屈曲畸形伴关节脱位矫形2例。结果 22例患者均获随访,随访时间12~72个月,平均36个月。10例骨缺损重建患者带架时间3~8个月,平均4.8个月;均获满意骨愈合,愈合时间3~16个月,平均6.4个月;末次随访时国际保肢学会功能评分93版(MSTS 93)评分为73.3~93.3分,平均87.2分;患者佩戴外固定架期间未出现并发症。5例骨延长患者带架时间7~15个月;2例延长过程中出现成角畸形,2例拆架后出现青枝骨折,CheckettsOtterburn外固定架钉道感染分级为轻度感染1级2例,2级1例;MSTS 93评分为80.0~96.7分,平均89.2分。其余患者均无相关并发症发生,膝关节及踝关节活动正常。结论 Orthofix单边外固定架可用于骨肿瘤切除后复杂缺损的固定,并可通过骨延长纠正儿童保肢术后肢体不等长问题。

Objective Based on images of pelvic CT three-dimensional reconstruction, to establish three-dimensional coordinate system of pelvis and investigate the three-axis displacement classification of pelvic fracture and its reduction principles. Methods Between June 2015 and May 2016, 21 cases of normal pelvic CT data were included in the study, and the mean pelvic three-dimensional model was established. The pelvic three-dimensional axis was established by defining the origin as the midpoint of the anterior superior iliac spine. Based on this coordinate system, a three-axis displacement classification of pelvic fracture were built. To assess the clinical guidance value of the three-axis classification, 55 cases （29 males and 26 females, aged 11-66 years with an average of 35.6 years） of pelvic fractures were analyzed by this classification, and replaced and fixed according to the principles of the reverse reduction. Results According to the theory of three-axis, pelvic fractures were divided into x-axis positive displacement/negative displacement, positive rotation/negative rotation; y-axis positive displacement/negative displacement, positive rotation/negative rotation; z-axis positive displacement/negative displacement, positive rotation/negative rotation. The average incision of included patients with pelvic fractures was 7.1 cm. The average reduction time was 12.2 minutes and the average radiation time was 55.3 s. The average time of screw implantation was 27.2 minutes. Postoperative pelvic X-ray films or three-dimensional CT showed all pelvic fracture was reducted well and the screw or plate was implanted correctly. The average intraoperative blood loss was 96.5 mL, the average operation time was 2.1 hours, and the average hospitalization time was 18.7 days. All patients were followed up 6-53 months （mean, 16.7 months）. At last follow-up, according to Matta standard by pelvic radiography evaluation, there were excellent in 39 cases, good in 13 cases, and fair in 3 cases, the excellent and good rate was 94.55%. Conclusion Based on three-dimensional coordinate system, three-axis displacement classification of pelvic fracture can illustrate the displacement mode of patient simply and accurately, and can also guide the intraoperative reduction precisely.