Arora Sumit, Batra Sumit, Gupta Vikas, Goyal Aman
Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
J Orthop Surg (Hong Kong). 2012 Aug;20(2):185-90. doi: 10.1177/230949901202000210.
To review records of 15 patients who underwent distraction osteogenesis/bone transport using a monolateral external fixator for infected non-union of the femoral shaft.
13 men and 2 women aged 18 to 47 years underwent adequate debridement and resection of nonviable bone, followed by bone transport using a monolateral external fixator for infected non-union of the femoral shaft with bone loss. All patients had a bone defect of >5 cm. The lengthening index, radiographic consolidation index, functional status, bone healing, and various problems, obstacles and complications encountered during the treatment were assessed.
The patients had undergone a mean of 2.9 (range, 1-7) surgical procedures before presentation. The mean duration from trauma to presentation was 7.7 (range, 6-18) months. The mean bone defect after adequate resection/debridement was 7.9 (range, 5.5-17) cm. The mean treatment duration was 7.3 (range, 5-15) months. The mean lengthening index was 12.3 (range, 11.5-15) days/cm. The mean treatment index was 27.9 (range, 24-40) days/cm. The mean follow-up duration was 19.3 (range, 15-41) months. Functional outcome was excellent in 5, good in 8, and fair in 2 patients. All patients achieved bone union and eradication of infection. Bone healing was excellent in 12 and good in 3 patients. All the patients were satisfied with the procedure. None had neurovascular complications, joint subluxations, or refracture of the regenerated bone. True complications encountered included knee stiffness (n=6) and knee flexion contracture (n=1). Three patients with an initial bone defect of >10 cm had delayed union and underwent bone grafting.
Bone transport using a monolateral external fixator is safe and effective for treating infected non-union of the femoral shaft.
回顾15例使用单侧外固定器进行牵张成骨/骨搬运治疗股骨干感染性骨不连患者的病历。
13例男性和2例女性，年龄18至47岁，接受了充分的清创和切除无活力骨，随后使用单侧外固定器进行骨搬运治疗伴有骨缺损的股骨干感染性骨不连。所有患者骨缺损均>5 cm。评估了延长指数、影像学愈合指数、功能状态、骨愈合情况以及治疗期间遇到的各种问题、障碍和并发症。
患者在就诊前平均接受了2.9次（范围1 - 7次）外科手术。从创伤到就诊的平均时间为7.7个月（范围6 - 18个月）。充分切除/清创后的平均骨缺损为7.9 cm（范围5.5 - 17 cm）。平均治疗时间为7.3个月（范围5 - 15个月）。平均延长指数为12.3天/cm（范围11.5 - 15天/cm）。平均治疗指数为27.9天/cm（范围24 - 40天/cm）。平均随访时间为19.3个月（范围15 - 41个月）。5例患者功能结果优秀，8例良好，2例一般。所有患者均实现骨愈合且感染消除。12例患者骨愈合优秀，3例良好。所有患者对手术满意。无一例发生神经血管并发症、关节半脱位或再生骨再骨折。真正遇到的并发症包括膝关节僵硬（n = 6）和膝关节屈曲挛缩（n = 1）。3例初始骨缺损>10 cm的患者出现延迟愈合并接受了植骨。
使用单侧外固定器进行骨搬运治疗股骨干感染性骨不连安全有效。
