Kusakabe Hiroshi, Ueoka Katsuhiko, Takayama Shinichiro, Seki Atsuhito
Division of Orthopedics, Department of Surgical Subspecialties, National Medical Center for Children and Mothers, National Center for Child Health and Development, Tokyo 157-8535, Japan.
Division of Urology, Department of Surgical Subspecialties, National Medical Center for Children and Mothers, National Center for Child Health and Development, Tokyo 157-8535, Japan.
J Orthop Sci. 2018 Jan;23(1):144-150. doi: 10.1016/j.jos.2017.08.021. Epub 2017 Oct 12.
In the patient of the cloacal exstrophy, cloaca with local abdominal wall is disrupted and exposed inner surface of the bladder needs early closure. Pelvic osteotomies are required for severe cases whose bladder cannot be closed by the suture of soft tissue only. We developed a technique involving the gradual positioning of bone fragments using a light, Ilizarov external fixator. The usefulness of the technique was assessed.
We enrolled 3 patients with cloacal exstrophy and 1 with bladder exstrophy as a gradual transfer group and 6 patients who were treated by other osteotomies as a control group. The patients aged 6.7-8.4 months at the time of surgery were followed up for 4.0-8.6 years. An external fixator with carbon fiber half-rings was placed to internally rotate and anteriorly move the distal bone fragment over 2 weeks. Then, the bladder was closed. Computed tomography (CT) images were used to assess the pelvis form. Wound dehiscence and number of the surgeries after the osteotomies are also compared between the two groups.
CT analysis of correction of the pelvic deformity achieved more and less decreasing its volumetric capacity in the gradual transfer group. No patients had wound dehiscence after the primary closure with pelvic osteotomy in the gradual transfer group but all had them in the control group. The mean number of the surgeries after the osteotomies were 2.25 in the gradual transfer group whereas 5.5 in the control group.
Sufficient closure of the abdominal wall and bladder was achieved in all cases in the gradual transfer group. The correction of pelvic bones were more with less decreasing of their pelvic capacities, no patients had wound dehiscence after the closure and there was an effect to decrease the number of the surgeries after the treatment by this method.
在泄殖腔外翻患者中，泄殖腔与局部腹壁破裂，暴露的膀胱内表面需要早期闭合。对于仅通过软组织缝合无法闭合膀胱的严重病例，需要进行骨盆截骨术。我们开发了一种使用轻便的伊里扎洛夫外固定器逐步定位骨碎片的技术。对该技术的有效性进行了评估。
我们纳入了3例泄殖腔外翻患者和1例膀胱外翻患者作为逐步转移组，6例接受其他截骨术治疗的患者作为对照组。手术时年龄为6.7 - 8.4个月的患者随访了4.0 - 8.6年。放置带有碳纤维半环的外固定器，在2周内使远端骨碎片向内旋转并向前移动。然后，闭合膀胱。使用计算机断层扫描（CT）图像评估骨盆形态。还比较了两组截骨术后的伤口裂开情况和手术次数。
CT分析显示，逐步转移组骨盆畸形矫正后骨盆容积或多或少有所减小。逐步转移组在骨盆截骨一期闭合后无患者出现伤口裂开，但对照组所有患者均出现伤口裂开。逐步转移组截骨术后的平均手术次数为2.25次，而对照组为5.5次。
逐步转移组所有病例均实现了腹壁和膀胱的充分闭合。骨盆骨的矫正效果较好，骨盆容积减小较少，闭合后无患者出现伤口裂开，且该方法治疗后有减少手术次数的效果。
