Eralp Levent, Kocaoglu Mehmet
Department of Orthopaedic Surgery and Traumatology, Istanbul Medical School, Istanbul University, Capa 34390, Istanbul, Turkey.
J Bone Joint Surg Am. 2008 Oct;90 Suppl 2 Pt 2:181-94. doi: 10.2106/JBJS.H.00467.
Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been introduced to overcome these problems. The present study investigates this combined technique.
Between 2002 and 2005, six patients, who ranged from seventeen to seventy years old, underwent distal tibial reconstruction and ankle arthrodesis with use of a circular external fixator and an intramedullary nail to treat a distal tibial defect following resection for chronic osteomyelitis or tumor or to treat a limb-length discrepancy combined with ankle instability. Functional and radiographic results were evaluated, with use of the criteria described by Paley et al., at an average follow-up of thirty-four months.
The mean size of the bone defect in three patients was 5.3 cm (2, 7, and 7 cm), and the mean amount of the limb-shortening in four patients was 5.25 cm (range, 4 to 6 cm). The mean external fixation time was 3.5 months, and the mean external fixator index was 0.57 mo/cm. There was no recurrence of infection in the two patients with osteomyelitis. All six patients had excellent bone results, and the functional results were excellent for two patients and good for four patients. There were four complications, three of which were categorized, according to Paley, as a problem (a difficulty that occurs during lengthening and is resolved without operative intervention) and one that was categorized as an obstacle (a difficulty that occurs during lengthening and needs operative treatment).
The combined technique is an improvement over the classic external fixation techniques of distal tibial reconstruction with ankle arthrodesis. It reduces the duration of external fixation, thus increasing patient acceptance, and it is associated with a low complication rate facilitating more rapid rehabilitation.
当存在骨缺损、肢体长度差异和/或踝关节不稳定时，使用外固定器进行胫骨远端重建会带来许多问题。为克服这些问题，引入了肢体延长、踝关节融合以及髓内钉节段性转移技术。本研究对这种联合技术进行了调查。
2002年至2005年期间，6例年龄在17岁至70岁之间的患者接受了胫骨远端重建和踝关节融合术，使用环形外固定器和髓内钉治疗慢性骨髓炎或肿瘤切除术后的胫骨远端缺损，或治疗合并踝关节不稳定的肢体长度差异。采用Paley等人描述的标准，在平均随访34个月时评估功能和影像学结果。
3例患者骨缺损的平均大小为5.3厘米（2厘米、7厘米和7厘米），4例患者肢体短缩的平均量为5.25厘米（范围为4至6厘米）。平均外固定时间为3.5个月，平均外固定器指数为0.57个月/厘米。2例骨髓炎患者均无感染复发。所有6例患者的骨结果均为优秀，2例患者的功能结果为优秀，4例患者为良好。有4例并发症，其中3例根据Paley的分类为问题（延长过程中出现的困难，无需手术干预即可解决），1例分类为障碍（延长过程中出现的困难，需要手术治疗）。
联合技术是对经典的胫骨远端重建联合踝关节融合外固定技术的改进。它缩短了外固定时间，从而提高了患者的接受度，且并发症发生率低，有利于更快康复。
