Arslan Hüseyin, Özkul Emin, Gem Mehmet, Alemdar Celil, Şahin İlhami, Kişin Bülent
*Department of Orthopaedics and Traumatology, Dicle University Medical Faculty †Department of Orthopaedics and Traumatology, Diyarbakir Training and Educational Hospital, Diyarbakir, Turkey.
J Pediatr Orthop. 2015 Mar;35(2):e8-12. doi: 10.1097/BPO.0000000000000392.
In this study, we evaluated the results of external bone transport, which was applied to 11 patients with traumatic bone loss who had not completed their bone development.
The average age of the 9 male and 2 female patients was 10.6 (range, 8 to 16) years. Eight of the defects were located in the tibia, whereas the other 3 were in the femur. The average defect was 5.4 (range, 4.5 to 8.5) cm. External bone transport was applied in the early period in 7 patients, whereas in 4 patients it was performed due to nonunion. Bifocal osteosynthesis and single osteotomy were performed in 2 patients with type B2 nonunion. Compression to the nonunion region and lengthening in the osteotomy region were applied. In 2 patients with type B1 nonunion, and the other 9 patients who had external bone transport, the gap was eliminated by bifocal osteosynthesis, single osteotomy, and bone transport to the osteotomy line.
The mean follow-up period was 21 (range, 13 to 48) months. Complete union was achieved in all patients without any bone operation or graft application. No refracture was observed after the removal of the external fixator, and the average hospitalization time was 16 (range, 7 to 65) days. The average external fixation time was 4.2 (range, 3.5 to 5.5) months, and the mean external fixator index was 0.8 months (23 d/cm). The mean bone healing time was 5.1 (range, 4.6 to 6) months.
To initially consider the open fractures with true or in situ bone loss in children as "anticipated nonunion," and determine the treatment strategies regarding this fact, may prevent nonunion and shorten the healing period. Bone transport in the treatment of traumatic bone defects in children is an easy biological procedure, with lower complications but higher success ratios.
Level IV-therapeutic.
在本研究中，我们评估了应用于11例未完成骨骼发育的创伤性骨缺损患者的外骨骼延长术的结果。
9例男性和2例女性患者的平均年龄为10.6岁（范围8至16岁）。8处骨缺损位于胫骨，另外3处位于股骨。平均骨缺损为5.4厘米（范围4.5至8.5厘米）。7例患者在早期应用了外骨骼延长术，而4例患者因骨不连进行了该手术。2例B2型骨不连患者进行了双焦点骨固定术和单截骨术。对骨不连区域进行加压，并在截骨区域进行延长。在2例B1型骨不连患者以及其他9例行外骨骼延长术的患者中，通过双焦点骨固定术、单截骨术以及向截骨线进行骨延长消除了骨间隙。
平均随访期为21个月（范围13至48个月）。所有患者均实现了完全愈合，无需任何骨手术或植骨。拆除外固定器后未观察到再骨折，平均住院时间为16天（范围7至65天）。平均外固定时间为4.2个月（范围3.5至5.5个月），平均外固定指数为0.8个月（23天/厘米）。平均骨愈合时间为5.1个月（范围4.6至6个月）。
最初将儿童真正或原位骨缺损的开放性骨折视为“预期骨不连”，并据此确定治疗策略，可能预防骨不连并缩短愈合期。儿童创伤性骨缺损治疗中的骨延长术是一种简单的生物学方法，并发症较少但成功率较高。
四级治疗性。
