Lawal Y Z, Garba E S, Ogirima M O, Dahiru I L, Maitama M I, Abubakar K, Ejagwulu F S
Department of Trauma and Orthopaedics, Ahmadu Bello University Zaria, Nigeria.
Ann Afr Med. 2011 Jan-Mar;10(1):25-8. doi: 10.4103/1596-3519.76571.
Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such conditions. In developing countries where such facilities or expertise may not be readily available, the surgeon has to rely on other techniques of treatment. Non-vascularized fibula strut graft and cancellous bone grafting provides a reliable means of treating such conditions in developing countries.
Over a period of six years all patients with segmental bone loss either from trauma or oncologic resection were included in the study. Data concerning the type of wound, size of gap and skin loss at tumor or fracture were obtained from clinical examination and radiographs.
Ten patients satisfied the inclusion criteria for the study. The average length of the fibula strut is 7 cm, the longest being 15 cm and the shortest 3 cm long. The average defect length was 6.5 cm. Five patients had Gustillo III B open tibial fractures. One patient had recurrent giant cell tumor of the distal radius and another had a polyostotic bone cyst of the femur, which was later confirmed to be osteosarcoma. Another had non-union of distal tibial fracture with shortening. One other patient had gunshot injury to the femur and was initially managed by skeletal traction. The tenth patient had a comminuted femoral fracture. All trauma patients had measurement of missing segment, tissue envelope assessment, neurological examination, and debridement under general anesthesia with fracture stabilization with external fixators or casts. Graft incorporation was 80% in all treated patients.
Autologous free, non-vascularized fibula and cancellous graft is a useful addition to the armamentarium of orthopedic surgeon in developing countries attempting to manage segmental bone loss, whether created by trauma or excision of tumors.
导致节段性骨缺损的骨折给骨科医生带来了挑战。发达国家的骨科医生可以选择带血管骨移植、骨搬运、同种异体骨移植、骨移植替代物以及其他几种方法来治疗此类病症。在那些此类设施或专业技术可能无法轻易获得的发展中国家，外科医生不得不依赖其他治疗技术。非带血管腓骨支撑植骨和松质骨植骨为发展中国家治疗此类病症提供了一种可靠的方法。
在六年的时间里，所有因创伤或肿瘤切除导致节段性骨缺损的患者都被纳入了该研究。通过临床检查和X光片获取有关伤口类型、骨缺损大小以及肿瘤或骨折部位皮肤缺损情况的数据。
十名患者符合该研究的纳入标准。腓骨支撑的平均长度为7厘米，最长为15厘米，最短为3厘米。平均缺损长度为6.5厘米。五名患者患有Gustillo III B型开放性胫骨骨折。一名患者患有桡骨远端复发性巨细胞瘤，另一名患者患有股骨多骨囊肿，后来被确诊为骨肉瘤。还有一名患者胫骨远端骨折不愈合并伴有短缩。另一名患者股骨遭受枪伤，最初采用骨牵引治疗。第十名患者患有股骨干粉碎性骨折。所有创伤患者均进行了缺失节段测量、组织覆盖评估、神经检查，并在全身麻醉下进行清创，同时使用外固定器或石膏固定骨折部位。所有接受治疗的患者植骨融合率为80%。
自体游离、非带血管腓骨和松质骨移植对于发展中国家试图处理因创伤或肿瘤切除造成的节段性骨缺损的骨科医生来说，是其治疗手段中的一项有用补充。
