Zhang Qun, Zhang Wei, Zhang Zhuo, Zhang Licheng, Chen Hua, Hao Ming, Deng Junhao, Tang Peifu
Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, People's Republic of China.
J Orthop Surg Res. 2017 Nov 25;12(1):183. doi: 10.1186/s13018-017-0684-y.
Currently, the common treatment for femoral nonunion with large segmental bone defect is difficult and complex. The effective surgical methods are rare, include vascularized bone grafting, Masquelet technique and Ilizarov distraction osteogenesis. The objective of this study is to investigate the outcomes of segmental femoral defects treated with monolateral external fixation using the distraction osteogenesis.
We retrospectively analyzed patients with femoral nonunion with segmental bone defects (> 6 cm) between January 2010 and January 2014 in our single trauma center. All patients were treated by distraction osteogenesis with monolateral external fixation. All surgeries were performed by the same surgeon. Bone union, duration of distraction osteogenesis in days, time to consolidation in months, external fixation index (EFI), complications, and additional surgical interventions were recorded postoperatively. The modified Application of Methods of Illizarov (ASAMI) criteria were used to evaluate the operative effectiveness.
Forty-one patients were enrolled in this study for analysis. The length of the bone defect ranged from 6 to 17 cm. All patients eventually achieved healing, and no patient experienced recurrence of infection or newly developed infection. The average time needed for healing was 13 months. In terms of the incidence of complications, 3 cases axial deviations, 5 cases docking site nonunion, 23 cases pin-tract infection, 14 cases knee joint stiffness or their joint mobility declined, 2 cases osteogenesis insufficient in the distraction area,1 case refracture, and 2 cases loose external fixation pins. In terms of the evaluations of fracture healing and function, 30 patients excellent, 6 patients good, 5 patients fair, and 0 patient poor. In terms of postoperative function evaluations, 21 patients excellent, 9 patients good, 7 patients fair, and 4 patients poor.
For patients with femoral nonunion with large segmental bone defects, the monolateral external fixation can provide effective stability, improve compliance, and reduce complications.
目前，股骨大段骨缺损不愈合的常规治疗困难且复杂。有效的手术方法较少，包括带血管蒂骨移植、Masquelet技术和Ilizarov牵张成骨术。本研究的目的是探讨采用单侧外固定牵张成骨术治疗股骨节段性骨缺损的疗效。
我们回顾性分析了2010年1月至2014年1月在我们单创伤中心就诊的股骨节段性骨缺损（>6cm）不愈合患者。所有患者均采用单侧外固定牵张成骨术治疗。所有手术均由同一位外科医生进行。术后记录骨愈合情况、牵张成骨天数、愈合时间（月）、外固定指数（EFI）、并发症及额外的手术干预情况。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41例患者进行分析。骨缺损长度为6至17cm。所有患者最终均实现愈合，且无患者出现感染复发或新发感染。愈合平均所需时间为13个月。并发症发生率方面，3例出现轴向偏差，5例对接部位不愈合，23例针道感染，14例膝关节僵硬或关节活动度下降，2例牵张区域成骨不足，1例再骨折及2例外固定针松动。骨折愈合及功能评估方面，30例患者为优，6例为良，5例为可，0例为差。术后功能评估方面，21例患者为优，9例为良，7例为可，4例为差。
对于股骨大段骨缺损不愈合患者，单侧外固定可提供有效的稳定性，提高依从性并减少并发症。
