Said Galal Zaki, Farouk Osama Ahmed, Said Hatem Galal
Department of Orthopedic Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.
Trauma Mon. 2013 Spring;18(1):32-6. doi: 10.5812/traumamon.8293. Epub 2013 May 26.
We report a case of non-union with severe shortening of the femur following diaphysectomy for chronic osteomyelitis.
A boy, aged 16 years presented with a dangling and excessively short left lower limb. He was using an elbow crutch in his right hand to help him walk. He had a history of diaphysectomy for chronic osteomyelitis at the age of 9. Examination revealed a freely mobile non-union of the left femur. The femur was the seat of an 18 cm shortening and a 4 cm defect at the non-union site; the knee joint was ankylosed in extension. The tibia and fibula were 10 cm short. Considering the extensive shortening in the femur and tibia in addition to osteoporosis, he was treated in two stages. In stage I, the femoral non-union was treated by open reduction, internal fixation and iliac bone grafting. The patient was then allowed to walk with full weight bearing in an extension brace for 7 months. In Stage II, equalization of leg length discrepancy (LLD) was achieved by simultaneous distraction of the femur and tibia by unilateral frames. At the 6 month follow- up, he was fully weight bearing without any walking aid, with a heel lift to compensate the 1.5 cm shortening. Three years later he reported that he was satisfied with the result of treatment and was leading a normal life as a university student.
Two-stage treatment succeeded to restore about 20 cm of the femoral shortening in a severely osteoporotic bone. It has also succeeded in reducing the treatment time of the external fixator.
我们报告一例慢性骨髓炎行骨干切除术后股骨严重短缩且不愈合的病例。
一名16岁男孩，左下肢悬吊且极度短小，右手使用肘拐辅助行走。他9岁时因慢性骨髓炎接受过骨干切除术。检查发现左股骨存在可自由活动的骨不连。股骨短缩18厘米，骨不连部位有4厘米缺损；膝关节伸直位强直。胫骨和腓骨短缩10厘米。鉴于股骨和胫骨广泛短缩以及骨质疏松，对他进行了两阶段治疗。第一阶段，通过切开复位、内固定和髂骨植骨治疗股骨骨不连。然后让患者在伸直支具中完全负重行走7个月。第二阶段，通过单侧框架同时牵引股骨和胫骨来实现下肢长度差异（LLD）的均衡。在6个月的随访中，他无需任何助行器完全负重行走，使用足跟垫来补偿1.5厘米的短缩。三年后，他报告对治疗结果满意，作为一名大学生过着正常生活。
两阶段治疗成功恢复了严重骨质疏松骨中约20厘米的股骨短缩，还成功缩短了外固定器的治疗时间。
