保留原始锁定板联合外固定架进行骨运输治疗股骨骨缺损

【作者】 王旭洋； 杨胜松； 黄雷； 夏志林； 明卫东； 滕星； 李铁军；

【机构】 河北省沧州中西医结合医院； 北京积水潭医院； 北京丰台右安门医院； 中国人民解放军陆军第八十一集团军医院；

【摘要】 目的探讨保留原始锁定板联合单边外固定架进行骨运输治疗股骨骨缺损的方法并总结其疗效。方法 2013年9月—2018年3月应用此方法治疗4例股骨骨缺损,男3例,女1例。平均年龄44.75岁(17岁-62岁)。平均缺损长度10.125厘米(6-14厘米),中远段缺损1例、远段缺损3例,左侧3例、右侧1例。手术先清理不愈合或缺损部位,修整残端,使骨面尽量平整,在保留原始股骨锁定板的基础上,在股骨前侧由前向后置入羟基磷灰石涂层固定半针,半针矢状面垂直于股骨解剖轴,先置入被运输骨段2枚半针,再置入股骨近端3枚半针,安装单边重建外固定架,于预定截骨平面多点钻孔法截骨。术后延迟7天后开始运输,1mm/d,共分4次完成。当股骨达到预期长度后,再次手术,经皮将2枚螺钉通过锁定板的锁定孔固定被运输骨段,然后拆除外固定架,开始功能锻炼。结果 4例患者均获得随访,平均28个月(16个月-46个月),骨运输长度平均10.125厘米(6-14厘米),外固定架放置时间平均3.73个月(2-5个月),外固定架指数平均0.37个月/cm(0.36-0.38个月/cm)。1例患者股骨被运输骨段在固定时出现少许偏移。最终所有病例对接端愈合,被运输骨段矿化良好。运输完成时膝关节活动范围平均37.5°(30°-45°),术后16个月膝关节活动范围平均90°(60°-120°)结论保留原始锁定板联合外固定架治疗股骨骨缺损能够明显缩短外固定架置放时间,避免肢体畸形,有利于早期膝关节功能锻炼,在治疗股骨大段骨缺损方面具有一定的优势。更多还原

【Abstract】 Objective: To review the results of limb lengthening over the original bone plates and the external fixator in management of femoral defect and length discrepancy.Methods: Femoral lengthening over Orthofix limb-reconstruction system and originalbone plates was applied to treat the mean gain in length was 10.125 cm(range, 6 to 14 cm),average 44.75 years(range,17 to 62 years),1 case of middle and far、3 cases of far,3 cases of left、1 case of right, for four cases from September 2013 to March 2018.The bone plates and external fixator were applied concomitantly at the time of femoral osteotomy. After a mean fixation time of 7 days, gradual distraction began at a rate of 0.25 millimeter four times a day. When the managed femur reached the expected length, the original bone plates was locked and the fixator was removed in patients with length discrepancy. Results All the patients was followed up for a mean time of 28 months(range,16 to 46 months). The mean gain in length was 10.125 cm(range, 6 to 14 cm) with good consolidation, the mean duration of external fixation was 3.73 months(range, 2 to 5 months),and the mean external fixation index was 0.37 month per centimeter(range,0.36 to 0.38 month per centimeter). In 1 patient, the femoral transport segment was sligthtly offset during fixation. Extend completion time, the mean range of movement of knee was 37.5°(30°-45°).All were unioned. Sixteen months after surgery, the mean range of movement of knee was 90°(60°-120°).Conclusion In management of defect and length discrepancy of limbs, lengthening over the original bone plates with the Orthofix limb-reconstruction system has the advantages of short duration of external fixation, good protection against refracture, and earlier rehabilitation of knee joint.It had certain advabtages in the treatment of segmental femoral defects and length discrepancy.更多还原