Beltran Michael J, Ochoa Leah M, Graves Richard M, Hsu Joseph R
United States Army Medical Corps, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
J Surg Orthop Adv. 2010 Spring;19(1):23-8.
The purpose of this article is to describe the use of shortening and angulation to manage composite bone and soft tissue loss associated with combat-related type IIIB open tibia fractures. Four patients underwent placement of a software-driven circular fixator with acute shortening and angulation to manage composite bone and soft tissue loss. Frames were applied using the Rings First Method, and an induced deformity was created with the soft tissue defect within the concavity. Distraction histiogenesis was utilized to restore limb length and regenerate soft tissues. Three patients had healed fractures and mature regenerate allowing frame removal, while one remained in his frame for further consolidation. Mechanical alignment and limb length were restored in all patients. No major frame adjustments were required and all distracted soft tissues healed without complication. The article concludes that composite bone and soft tissue loss is effectively managed with distraction histiogenesis and the use of a software-driven circular fixator.
本文的目的是描述通过缩短和成角来处理与战斗相关的ⅢB型开放性胫骨骨折所伴发的复合性骨与软组织缺损。4例患者接受了软件驱动的环形固定器置入术，并进行急性缩短和成角以处理复合性骨与软组织缺损。采用环优先法应用外固定架，并在凹面内的软组织缺损处造成诱导性畸形。利用牵张组织生成来恢复肢体长度并再生软组织。3例患者骨折愈合且再生组织成熟，可拆除外固定架，而1例患者仍保留外固定架以进一步促进骨愈合。所有患者均恢复了机械对线和肢体长度。无需对外固定架进行重大调整，所有牵张的软组织均顺利愈合，无并发症发生。本文得出结论，牵张组织生成及使用软件驱动的环形固定器可有效处理复合性骨与软组织缺损。
