Watanabe Koji, Tsuchiya Hiroyuki, Sakurakichi Keisuke, Yamashiro Teruhisa, Matsubara Hidenori, Tomita Katsuro
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
J Orthop Sci. 2007 Sep;12(5):471-5. doi: 10.1007/s00776-007-1163-9. Epub 2007 Sep 28.
In this study, we addressed two questions on the treatment for Ollier's disease: (1) how much callus formation occurs when an osteotomy is performed intralesionally and (2) how is the stability of the wires and half-pins that are inserted intralesionally.
Four children with Ollier's disease underwent treatment of 12 lower limb segments using distraction osteogenesis until completion of their growth. All osteotomies were performed at the centers of the deformities, resulting in a total of seven osteotomies performed intralesionally.
Full correction of the deformity and full restoration of length were achieved in all cases, but a residual limb-length discrepancy of <10 mm remained. The mean external fixation index in the intralesional distraction osteogenesis group was 39.7 days/cm versus 30.8 days/cm in the extralesional distraction osteogenesis group. Conversion from abnormal cartilage to normal regenerate bone was seen in only one segment. Although approximately two-thirds of the wires and half-pins were inserted intralesionally, in all but one case (in which an iatrogenic fracture occurred) the wires and half-pins were well stabilized throughout the external fixation period.
Although deformity and limb-length discrepancies due to Ollier's disease were successfully resolved by distraction osteogenesis, enchondroma may arise in distracted calluses when osteotomized intralesionally. However, the stability of the external fixator was sufficient to lengthen limbs and correct deformities even when wires and half-pins were inserted intralesionally.
在本研究中，我们探讨了关于骨软骨瘤病治疗的两个问题：（1）病灶内截骨时会形成多少骨痂，以及（2）病灶内插入的钢丝和半针的稳定性如何。
4例骨软骨瘤病患儿的12个下肢节段采用牵张成骨治疗直至生长完成。所有截骨均在畸形中心进行，共进行了7次病灶内截骨。
所有病例均实现了畸形的完全矫正和长度的完全恢复，但仍残留肢体长度差异<10 mm。病灶内牵张成骨组的平均外固定指数为39.7天/cm，而病灶外牵张成骨组为30.8天/cm。仅在一个节段观察到异常软骨转化为正常再生骨。虽然约三分之二的钢丝和半针插入病灶内，但除1例（发生医源性骨折）外，在整个外固定期间钢丝和半针均固定良好。
虽然骨软骨瘤病所致的畸形和肢体长度差异通过牵张成骨成功解决，但病灶内截骨时，牵张骨痂中可能出现内生软骨瘤。然而，即使钢丝和半针插入病灶内，外固定器的稳定性也足以延长肢体并矫正畸形。
