Meffert Rainer H, Jansen Hendrik, Frey Sönke P, Raschke Michael J, Langer Martin
Department of Trauma-, Hand-, and Plastic Surgery, University of Würzburg, Oberdürrbacher Str. 1, D-97080 Würzburg, Germany.
Clin Orthop Relat Res. 2007 Jul;460:202-9. doi: 10.1097/BLO.0b013e31804a5e12.
Reconstructing posttraumatic tibial defects is often challenging. Some authors recommend acute limb shortening. We determined whether soft tissue trauma affects the formation of regenerated bone after acute shortening and monofocal lengthening. Twenty-two rabbits were divided into two equal groups. In the test group, 90 minutes of ischemia and 30 minutes of tibialis anterior muscle contusion at 100 kPa induced substantially elevated pressure as an onset of compartment syndrome. The untreated hind limb acted as the paired control. An external fixator was applied and the limb was shortened 10 mm through bone resection. After a latency period, distraction was performed for 10 days until the natural length was restored. New bone formation was evaluated mechanically, radiographically, and histomorphometrically. Osseous consolidation occurred in all animals. Normalized mechanical values of the newly reconstructed tibia indicated torsional strength was lower in the trauma group than in controls (46% +/- 18.5% versus 64% +/- 16.7%). Average normalized callus diameters were smaller in the trauma group than in controls (1.27 +/- 0.14 versus 1.6 +/- 0.16), as were callus volumes (37% +/- 5.9% versus 44% +/- 10.3%). Although soft tissue trauma affected the formation of regenerated bone, our results suggest reconstruction of tibial defects using a monofocal technique is consistent, even in the presence of blunt trauma and elevated compartment pressure.
重建创伤后胫骨缺损往往具有挑战性。一些作者推荐急性肢体缩短。我们确定软组织创伤是否会影响急性缩短和单焦点延长后再生骨的形成。将22只兔子平均分为两组。在试验组中，通过在100 kPa下造成90分钟缺血和30分钟胫前肌挫伤，诱导产生明显升高的压力作为骨筋膜室综合征的起始。未处理的后肢作为配对对照。应用外固定器，通过骨切除将肢体缩短10 mm。经过一段潜伏期后，进行10天的牵张直至恢复自然长度。通过力学、放射学和组织形态计量学评估新骨形成情况。所有动物均发生骨愈合。新重建胫骨的标准化力学值表明，创伤组的扭转强度低于对照组（46%±18.5%对64%±16.7%）。创伤组的平均标准化骨痂直径小于对照组（1.27±0.14对1.6±0.16），骨痂体积也是如此（37%±5.9%对44%±10.3%）。尽管软组织创伤影响再生骨的形成，但我们的结果表明，即使存在钝性创伤和骨筋膜室内压力升高，使用单焦点技术重建胫骨缺损也是可行的。
