Wang Bin, Jia Song, Lu Aidong, Qin Sihe, Liu Wei, Hao Ruizheng, Wang Wei, Huo Yongxin, Zhao Gang
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Nov;29(11):1348-52.
To explore the effectiveness of bone transportation by ring type extenal fixator combined with locked intramedullary nail for tibial non-infectious defect.
Between June 2008 and October 2012, 22 cases of tibial large segment defect were treated. There were 15 males and 7 females, aged 24-58 years (mean, 36.8 years), including 17 cases of postoperative nonunion or malunion healing, and 5 cases of large defect. After debridement, bone defect size was 5.0-12.5 cm (mean, 8.05 cm). Bone transportation was performed by ring type external fixator combined with locked intramedullary nail, the mean indwelling duration of external fixation was 10.2 months (range, 2-26 months); the external fixation index was 1.57 months/cm (range, 0.3-3.2 months/cm); and the mean length increase was 8.05 cm (range, 5.0-12.5 cm).
All patients were followed up 19-58 months (mean, 32 months). No infection occurred after operation and all patients obtained bony union, and the union time was 4.7-19.4 months (mean, 11.9 months). Complications included refracture (1 case), skin crease (1 case), lengthening failure (1 case), foot drop (2 cases), retractions of the transport segment (1 case), delay of mineralization (1 case), which were cured after corresponding treatment. According to Hohl knee evaluation system to assess knee joint function after removal of external fixator and intramedullary nail, the results were excellent in 15 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 90.9%; according to Baird-Jackson ankle evaluation system to evaluate ankle joint function, the results were excellent in 10 cases, good in 3 cases, fair in 7 cases, and poor in 2 cases, with an excellent and good rate of 59.1%.
Bone transportation by ring type external fixator combined with locked intramedullary nail could increase stability of extremities, allow early removal of external fixator and avoid axis shift of extremities, so it has good effect in treating tibial noninfectious defect.
探讨环形外固定器结合带锁髓内钉治疗胫骨非感染性骨缺损的有效性。
2008年6月至2012年10月，治疗22例胫骨大段骨缺损患者。男15例，女7例，年龄24 - 58岁（平均36.8岁），其中术后骨不连或畸形愈合17例，大段骨缺损5例。清创后，骨缺损长度为5.0 - 12.5 cm（平均8.05 cm）。采用环形外固定器结合带锁髓内钉进行骨搬运，外固定平均留置时间为10.2个月（范围2 - 26个月）；外固定指数为1.57个月/cm（范围0.3 - 3.2个月/cm）；平均延长长度为8.05 cm（范围5.0 - 12.5 cm）。
所有患者随访19 - 58个月（平均32个月）。术后无感染发生，所有患者均获得骨性愈合，愈合时间为4.7 - 19.4个月（平均11.9个月）。并发症包括再骨折（1例）、皮肤皱折（1例）、延长失败（1例）、足下垂（2例）、骨段回缩（1例）、骨矿化延迟（1例），经相应治疗后均治愈。根据Hohl膝关节评价系统对外固定器和髓内钉取出后膝关节功能进行评估，结果优15例，良5例，可2例，优良率为90.9%；根据Baird - Jackson踝关节评价系统对踝关节功能进行评估，结果优10例，良3例，可7例，差2例，优良率为59.1%。
环形外固定器结合带锁髓内钉进行骨搬运可增加肢体稳定性，允许早期拆除外固定器并避免肢体轴线偏移，治疗胫骨非感染性骨缺损效果良好。
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