Zhang Qun, Zhang Wei, Zhang Zhuo, Tang Peifu, Zhang Lihai, Chen Hua
Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, No. 28, Beijing, 100853, People's Republic of China.
Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, No. 28, Beijing, 100853, People's Republic of China.
Injury. 2017 Oct;48(10):2270-2275. doi: 10.1016/j.injury.2017.07.010. Epub 2017 Jul 12.
A variety of approaches have been used to treat oligotrophic or atrophic non-union. Conventional methods are often associated with great operative trauma, increased blood loss, a risk of re-infection, higher medical costs, and complications at the donor site. This study aimed to assess the clinical efficacy of the accordion technique combined with Minimally Invasive Percutaneous Decortication (MIPD) for these types of bone non-union.
From January 2010 to December 2015, 20 patients with long bone aseptic non-unions of the lower extremities without bone defects who were treated with the accordion technique combined with MIPD. The limb-length discrepancy (LLD) was less than 2cm in all patients. None of the patients received autogenous bone grafts during follow-up. All surgeries were performed by the same surgeon, and the modified Application of methods of Ilizarov (ASAMI) criteria were used to evaluate the operative effectiveness.
A total of 20 patients were included in this study, and 1 patient was lost during follow-up. Fifteen of these patients presented with oligotrophic non-unions, and 5 patients presented with atrophic non-unions. The average follow-up period in these patients was 12.1 months (range: 8-42 months). The alternative compression and distraction procedure was repeated 1-3 times. Blood loss was 30 to 250ml during surgery. Ultimately, bone union was achieved in 19 patients and failed in 1 patient. The fractures healed within 4-8 months (average time: 5.9 months), and fracture healing was considered excellent in 19 patients and poor in 1 patient. Postoperative function was evaluated as excellent in 9 patients, good in 6 patients, fair in 4 patients, and poor in 1 patient.
The accordion technique combined with MIPD, which is a simple, minimally invasive procedure that does not require autologous bone grafting, resulted in a high bone union rate and good postoperative function.
已采用多种方法治疗营养性不良或萎缩性骨不连。传统方法往往伴随着较大的手术创伤、失血增加、再次感染风险、较高的医疗成本以及供区并发症。本研究旨在评估手风琴技术联合微创经皮去皮质术（MIPD）治疗此类骨不连的临床疗效。
2010年1月至2015年12月，20例下肢长骨无菌性骨不连且无骨缺损的患者接受了手风琴技术联合MIPD治疗。所有患者的肢体长度差异（LLD）均小于2cm。随访期间所有患者均未接受自体骨移植。所有手术均由同一位外科医生进行，并采用改良的伊里扎洛夫方法应用（ASAMI）标准评估手术效果。
本研究共纳入20例患者，1例在随访期间失访。其中15例为营养性不良骨不连，5例为萎缩性骨不连。这些患者的平均随访时间为12.1个月（范围：8 - 42个月）。交替加压和牵张操作重复1 - 3次。手术期间失血量为30至250ml。最终，19例患者实现骨愈合，1例失败。骨折在4 - 8个月内愈合（平均时间：5.9个月），19例患者的骨折愈合情况被评为优秀，1例为差。术后功能评估为优秀的有9例，良好的有6例，中等的有4例，差的有1例。
手风琴技术联合MIPD是一种简单、微创的手术，无需自体骨移植，具有较高的骨愈合率和良好的术后功能。
