Baumgart R, Schuster B, Baumgart T
ZEM-Germany, Zentrum für korrigierende und rekonstruktive Extremitätenchirurgie München, Nymphenburgerstraße 1, 80336, München, Deutschland.
Orthopade. 2017 Aug;46(8):673-680. doi: 10.1007/s00132-017-3441-3.
The method of "callus distraction" is the only technique which spontaneously produces vascularized bone within the surrounding soft tissues during lengthening reconstructive procedures. Remodeling of the regenerate bone to specific mechanical load can be influenced by the surgeon. In principle, there is no limit to the amount of new bone formation which can be created; this vascularized bone is both resistant to infection and can be created to replace resected infected bone. This is an important prerequisite for the successful treatment of large bone defects.
The ring fixator is still a standard tool if no radiological control is available in the operating theater, or in other less sophisticated environments. Over the last 30 years, however, the development of motorized, external and fully implantable systems has made it possible to achieve a significant increase in device implementation, which goes far beyond the standard.
High-performance, reliable, custom-made external and fully implantable systems are cost intensive and require special surgical skills, which can only be ensured at specialized centers. However, the complication-free treatment results justify the effort both for the patient and, ultimately, for the cost bearers.
“骨痂牵张”方法是在延长重建手术过程中唯一能在周围软组织内自发产生血管化骨的技术。再生骨对特定机械负荷的重塑可受外科医生影响。原则上，新骨形成的量没有限制；这种血管化骨既抗感染，又可用于替代切除的感染骨。这是成功治疗大骨缺损的重要前提。
如果手术室内没有放射学控制手段，或在其他不太先进的环境中，环形固定器仍是一种标准工具。然而，在过去30年里，电动、外部和完全可植入系统的发展使得设备的应用显著增加，远远超出了标准。
高性能、可靠的定制外部和完全可植入系统成本高昂，需要特殊的手术技能，只有在专业中心才能确保。然而，无并发症的治疗结果对患者以及最终对费用承担者来说，都是值得付出努力的。
