Meselhy Mohammed Anter, Singer Mohamed Salah, Halawa Abdelsamie M, Hosny Gamal Ahmed, Adawy Adel H, Essawy Osama M
Orthopedic Department, Benha University, El-Shaheed Farid Nada Street, Kafer el Gazar, Banha, Qalyubia, 13511, Egypt.
Arch Orthop Trauma Surg. 2018 May;138(5):653-660. doi: 10.1007/s00402-018-2895-z. Epub 2018 Feb 7.
Several reconstructive procedures have been used in management of large tibial bone defects including bone graft, bone transport (distraction osteogenesis) using various external fixators, and vascularized bone graft. Each of these procedures has its limitations and complications. The study describes gradual medial fibular transfer using Ilizarov external fixators in management of patients with large tibial defect, either following infection or trauma.
Between May 2011 and June 2013, 14 patients were prospectively included in the current study. The inclusion criteria were large tibial defect due to trauma or infection with severe soft tissue compromise, and small or poor tibial bone remnants making bone lengthening difficult. Exclusion criteria were patients with vascular or nerve injuries. The average age of the patients was 31.64 (± 6.5) years. Medial fibular transfer was done for all patients using Ilizarov at a rate of 0.5 mm twice daily. Iliac bone graft was used in all patients after the transfer.
The average segmental bone defect of the tibia was (13.2 ± 2.6), ranging between 8 and 18.6 cm. Union was achieved in all patients with average fixator time was 32.42 (± 4.32) weeks. Average follow-up after removal of the fixator was 40.5 (± 6.9) months.
Gradual fibular transfer by Ilizarov external fixator is a reliable technique in management of post-traumatic and post-infection large tibial bone defects with good clinical outcome, and with few complications.
几种重建手术已被用于治疗大型胫骨骨缺损，包括骨移植、使用各种外固定器的骨搬运（牵张成骨）以及带血管蒂骨移植。这些手术中的每一种都有其局限性和并发症。本研究描述了使用伊利扎罗夫外固定器进行腓骨逐步内侧转移，以治疗大型胫骨缺损患者，这些患者或是感染后或是创伤后导致的缺损。
在2011年5月至2013年6月期间，14例患者被前瞻性纳入本研究。纳入标准为因创伤或感染导致大型胫骨缺损且伴有严重软组织损伤，以及胫骨骨残余小或质量差致使骨延长困难。排除标准为伴有血管或神经损伤的患者。患者的平均年龄为31.64（±6.5）岁。所有患者均使用伊利扎罗夫外固定器进行腓骨内侧转移，每天两次，每次0.5毫米。转移后所有患者均使用髂骨移植。
胫骨的平均节段性骨缺损为（13.2±2.6），范围在8至18.6厘米之间。所有患者均实现骨愈合，平均固定器使用时间为32.42（±4.32）周。去除固定器后的平均随访时间为40.5（±6.9）个月。
伊利扎罗夫外固定器进行腓骨逐步转移是治疗创伤后和感染后大型胫骨骨缺损的可靠技术，临床效果良好，并发症少。
