Rahimnia Alireza, Fitoussi Frank, Penneçot George, Mazda Keywan
Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
Department of Orthopedic Surgery Robert-Débre Hospital, Paris, France.
Trauma Mon. 2012 Jan;16(4):154-9. doi: 10.5812/kowsar.22517464.3184. Epub 2012 Jan 15.
Segmental defects of the tibia are challenging therapeutic problems for both the physician and the patient. These defects may be caused by severe trauma, infection, tumors and congenital processes. Several different techniques have been described for treatment of these defects including the Papineau technique, allograft reconstruction, bone transport using the Ilizarov frame, free vascularized fibular graft, tibiofibular synostosis and medial transport of the fibula with Tuli's technique, use of the Ilizarov frame and Huntington's procedure. All of these techniques have their specific advantages as well as disadvantages. Some of these techniques are used rarely i.e. the Papineau technique. The procedure of choice for most large tibial defects is bone transport with Ilizarov's technique; but in some cases the tibial remnant is inadequate for lengthening and we must use alternative treatments. In the three aforementioned techniques, the fibula is transferred with peroneal and anterior tibial muscles on a pedicle of peroneal vessels. This transfer retains a biological component of vital bone that allows for a shorter time for consolidation, increased remodeling potential and resistance to infection. It also has better long-term mechanical properties. Hypertrophy of the centralized fibula is described as attaining twice its original diameter or twice the size of the contralateral tibia. Hypertrophy has been seen in nearly all cases of the fibular centralization. Maximum hypertrophy is seen in children and besides patient age, is related to bony union and weight bearing. The reported time for hypertrophy of fibula varies from one to four years. No significant change in the diameter of the fibula was observed after five years. Fracture of tibialized fibula was not reported in many studies of fibular centralization with different techniques. In the reviewed articles, there were no cases of valgus deformity of the ankle. Either the patients were satisfied with the final results despite appearance of the lower extremity and the presence of some angular deformities, although in most cases, the deformities were mild. In this review we conclude that tibialisation of the fibula in selected cases is a reasonable alternative for the treatment of massive tibial defects.
胫骨节段性缺损对医生和患者来说都是具有挑战性的治疗难题。这些缺损可能由严重创伤、感染、肿瘤和先天性疾病引起。已经描述了几种不同的治疗这些缺损的技术，包括帕皮诺技术、同种异体骨重建、使用伊里扎洛夫框架的骨搬运、游离带血管腓骨移植、胫腓骨融合以及采用图利技术的腓骨内侧搬运、使用伊里扎洛夫框架和亨廷顿手术。所有这些技术都有其特定的优点和缺点。其中一些技术很少使用，即帕皮诺技术。大多数大型胫骨缺损的首选治疗方法是采用伊里扎洛夫技术进行骨搬运；但在某些情况下，胫骨残端不足以进行延长，我们必须采用替代治疗方法。在上述三种技术中，腓骨通过腓骨和胫前肌在腓血管蒂上进行转移。这种转移保留了重要骨组织的生物学成分，使得骨愈合时间更短、重塑潜力增加且抗感染能力增强。它还具有更好的长期力学性能。中央化腓骨的肥大被描述为达到其原始直径的两倍或对侧胫骨大小的两倍。几乎在所有腓骨中央化的病例中都观察到了肥大。肥大在儿童中最为明显，除了患者年龄外，还与骨愈合和负重有关。报道的腓骨肥大时间从一年到四年不等。五年后未观察到腓骨直径有明显变化。在许多采用不同技术的腓骨中央化研究中，未报道胫骨化腓骨骨折。在综述的文章中，没有踝关节外翻畸形的病例。尽管下肢外观存在一些角形畸形，但患者对最终结果大多感到满意，不过在大多数情况下，畸形较轻。在本综述中，我们得出结论，在特定病例中，腓骨胫骨化是治疗大面积胫骨缺损的一种合理替代方法。
