BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone...BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies,including congenital deficiencies.Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis,and present preliminary results of this technological solution.METHODS Seven adults with post-traumatic tibial defects(subgroup A)and nine children(subgroup B)with congenital pseudarthrosis of the tibia(CPT)were treated with the combination of IMT and IBT after the failure of previous treatments.The mean number of previous surgeries was 2.0±0.2 in subgroup A and 3.3±0.7 in subgroup B.Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal.Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane,its compression and docking for consolidation without grafting.The outcomes were retrospectively studied after a mean follow-up of 20.8±2.7 mo in subgroup A and 25.3±2.3 mo in subgroup B.RESULTS The“true defect”after resection was 13.3±1.7%in subgroup A and 31.0±3.0%in subgroup B relative to the contralateral limb.Upon completion of treatment,defects were filled by 75.4±10.6%and 34.6±4.2%,respectively.Total duration of external fixation was 397±9.2 and 270.1±16.3 d,including spacer retention time of 42.4±4.5 and 55.8±6.6 d,in subgroups A and B,respectively.Bone infection was not observed.Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups.Ischemic regeneration was observed in two cases of subgroup B.Complications were corrected during the course of treatment.Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B.One non-united CPT case was further treated with the Ilizarov compression method only and achieved union.After a follow-up period of two to three years,refractures occurred in four cases of united CPT.CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention.Refractures may occur in severe CPT.展开更多
Background:This study aimed to investigate the relationship between postoperative complications and fibular integrity in congenital pseudarthrosis of the tibia (CPT) in children.Methods:A retrospective study was perfo...Background:This study aimed to investigate the relationship between postoperative complications and fibular integrity in congenital pseudarthrosis of the tibia (CPT) in children.Methods:A retrospective study was performed in 59 patients with Crawford type Ⅳ CPT who were treated with combined surgical technique from 2007 to 2011.The patients were divided into two groups,the CPT with fibular pseudarthrosis (group A) and CPT with intact fibula groups (group B),on the basis of fibula status after the union of CPT.The incidence rates of refracture,ankle vaigus,tibial valgus,and limb length discrepancy in the two groups were investigated.Results:In group A,14 (36.8%) cases had refracture,30 (78.9%) had ankle valgus;27 (71%) exhibited tibial valgus with an average tibial valgus of 7 (6-20),and 24 (63.2%) had limb length discrepancy with an average limb length of 1.26 cm (0.6-4.4 cm).In group B,2 (9.5%) cases had refracture,11 (52.4%) had ankle valgns,8 (42.9%) had tibial valgus with an average tibial valgus deformity of 2.9 (6-13),and 13 (61.9%) had limb length discrepancy with an average limb length of 1.48 cm (0.5-5 cm).Significant difference in refracture and ankle valgus was found between groups A and B (P<0.05).Conclusions:After the union of CPT,patients with fibular pseudarthrosis showed higher incidence of refracture and ankle valgus than those with intact fibula.Attention should be paid to the presence of fibular pseudarthrosis when managing CPT.展开更多
目的评估儿童先天性胫骨假关节(congenital pseudarthrosis of the tibia,CPT)行胫骨近端延长的愈合指数及并发症情况。方法回顾性分析2012年2月至2019年12月湖南省儿童医院骨科使用伊氏外固定装置行胫骨近端延长手术的57例CPT患儿临床...目的评估儿童先天性胫骨假关节(congenital pseudarthrosis of the tibia,CPT)行胫骨近端延长的愈合指数及并发症情况。方法回顾性分析2012年2月至2019年12月湖南省儿童医院骨科使用伊氏外固定装置行胫骨近端延长手术的57例CPT患儿临床资料,平均随访时间72.9个月。根据愈合指数的平均值分组,愈合指数小于57.1 d/cm为A组(n=32),大于57.1 d/cm为B组(n=25)。于胫骨近端延长治疗结束后1个月行X线检查,采用Li分类法评估骨痂质量,并随访患儿胫骨延长术后并发症情况。结果57例CPT患儿平均愈合指数为57.1 d/cm。A组手术时平均年龄为80个月,平均随访时间为75.5个月,平均延长长度为5.9 cm,延长结束后1个月骨痂形态质量良好者占81%(26/32),愈合指数为39.1 d/cm。B组手术时平均年龄为100.9个月,平均随访时间为69.6个月,平均延长长度为4.9 cm,延长结束后1个月骨痂形态良好者占56%(14/25),愈合指数为80.1 d/cm。57例中,3例于胫骨延长过程中腓骨提前愈合,5例出现针道感染,3例踝关节僵硬,1例出现踝关节跖屈20°畸形,4例出现延长段成角畸形,8例膝关节活动受限。结论CPT患儿胫骨延长过程中平均愈合指数为57.1 d/cm,存在腓骨提前愈合、延长段成角畸形等并发症,延长过程中需密切关注骨痂形态。展开更多
目的比较先天性胫骨假关节(congenital pseudarthrosis of tibia,CPT)和正常儿童血清外泌体中蛋白的表达差异,寻找CPT的可能致病机制。方法收集湖南省儿童医院6例CPT患儿和4例正常儿童的静脉血,通过分离出静脉血清、提取血清外泌体,使...目的比较先天性胫骨假关节(congenital pseudarthrosis of tibia,CPT)和正常儿童血清外泌体中蛋白的表达差异,寻找CPT的可能致病机制。方法收集湖南省儿童医院6例CPT患儿和4例正常儿童的静脉血,通过分离出静脉血清、提取血清外泌体,使用串联质谱标签(tandem mass tag,TMT)标记定量蛋白组学技术,确定CPT患儿和正常儿童血清外泌体中的差异表达蛋白,并对差异蛋白进行GO分析、KEGG分析、DisGeNET富集分析及PPI分析。结果与正常儿童血清中外泌体蛋白相比,CPT来源的血清外泌体中表达上调的蛋白共121个,表达下调的蛋白共289个。KEGG分析结果显示,差异蛋白在补体系统富集最为显著;糖代谢在GO分类中的生物进程中富集;DisGeNET富集分析结果显示,排名前五的疾病中有3种和骨质疏松症有关;PPI富集分析结果显示糖代谢为差异蛋白富集模块之一。结论补体系统紊乱和细胞能量代谢异常可能是CPT的潜在致病机制。本研究为探索先天性胫骨假关节的病因及发病机制提供了新的思路。展开更多
文摘BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies,including congenital deficiencies.Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis,and present preliminary results of this technological solution.METHODS Seven adults with post-traumatic tibial defects(subgroup A)and nine children(subgroup B)with congenital pseudarthrosis of the tibia(CPT)were treated with the combination of IMT and IBT after the failure of previous treatments.The mean number of previous surgeries was 2.0±0.2 in subgroup A and 3.3±0.7 in subgroup B.Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal.Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane,its compression and docking for consolidation without grafting.The outcomes were retrospectively studied after a mean follow-up of 20.8±2.7 mo in subgroup A and 25.3±2.3 mo in subgroup B.RESULTS The“true defect”after resection was 13.3±1.7%in subgroup A and 31.0±3.0%in subgroup B relative to the contralateral limb.Upon completion of treatment,defects were filled by 75.4±10.6%and 34.6±4.2%,respectively.Total duration of external fixation was 397±9.2 and 270.1±16.3 d,including spacer retention time of 42.4±4.5 and 55.8±6.6 d,in subgroups A and B,respectively.Bone infection was not observed.Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups.Ischemic regeneration was observed in two cases of subgroup B.Complications were corrected during the course of treatment.Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B.One non-united CPT case was further treated with the Ilizarov compression method only and achieved union.After a follow-up period of two to three years,refractures occurred in four cases of united CPT.CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention.Refractures may occur in severe CPT.
文摘Background:This study aimed to investigate the relationship between postoperative complications and fibular integrity in congenital pseudarthrosis of the tibia (CPT) in children.Methods:A retrospective study was performed in 59 patients with Crawford type Ⅳ CPT who were treated with combined surgical technique from 2007 to 2011.The patients were divided into two groups,the CPT with fibular pseudarthrosis (group A) and CPT with intact fibula groups (group B),on the basis of fibula status after the union of CPT.The incidence rates of refracture,ankle vaigus,tibial valgus,and limb length discrepancy in the two groups were investigated.Results:In group A,14 (36.8%) cases had refracture,30 (78.9%) had ankle valgus;27 (71%) exhibited tibial valgus with an average tibial valgus of 7 (6-20),and 24 (63.2%) had limb length discrepancy with an average limb length of 1.26 cm (0.6-4.4 cm).In group B,2 (9.5%) cases had refracture,11 (52.4%) had ankle valgns,8 (42.9%) had tibial valgus with an average tibial valgus deformity of 2.9 (6-13),and 13 (61.9%) had limb length discrepancy with an average limb length of 1.48 cm (0.5-5 cm).Significant difference in refracture and ankle valgus was found between groups A and B (P<0.05).Conclusions:After the union of CPT,patients with fibular pseudarthrosis showed higher incidence of refracture and ankle valgus than those with intact fibula.Attention should be paid to the presence of fibular pseudarthrosis when managing CPT.
文摘目的比较先天性胫骨假关节(congenital pseudarthrosis of tibia,CPT)和正常儿童血清外泌体中蛋白的表达差异,寻找CPT的可能致病机制。方法收集湖南省儿童医院6例CPT患儿和4例正常儿童的静脉血,通过分离出静脉血清、提取血清外泌体,使用串联质谱标签(tandem mass tag,TMT)标记定量蛋白组学技术,确定CPT患儿和正常儿童血清外泌体中的差异表达蛋白,并对差异蛋白进行GO分析、KEGG分析、DisGeNET富集分析及PPI分析。结果与正常儿童血清中外泌体蛋白相比,CPT来源的血清外泌体中表达上调的蛋白共121个,表达下调的蛋白共289个。KEGG分析结果显示,差异蛋白在补体系统富集最为显著;糖代谢在GO分类中的生物进程中富集;DisGeNET富集分析结果显示,排名前五的疾病中有3种和骨质疏松症有关;PPI富集分析结果显示糖代谢为差异蛋白富集模块之一。结论补体系统紊乱和细胞能量代谢异常可能是CPT的潜在致病机制。本研究为探索先天性胫骨假关节的病因及发病机制提供了新的思路。
