Ji Tao, Guo Wei, Yang Rongli, Tang Xiaodong, Li Dasen, Yang Yi
Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, 100044, P.R.China.
Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, 100044,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Oct 15;31(10):1161-1167. doi: 10.7507/1002-1892.201705005.
To investigate the surgical characteristics and preliminary effectiveness of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors.
Twenty-two patients received Orthofix unilateral external fixator treatment for bone defect after tumor excision or complications after limb salvage surgery between June 2011 and March 2016. There were 11 males and 11 females with a median age of 23.5 years (range, 4-57 years). The bone defect or limb length discrepancy after tumor resection was at proximal femur in 6 cases, distal femur in 8 cases, diaphysis of femur in 3 cases, proximal tibia in 2 cases, and diaphysis of tibia in 3 cases. The external fixation was used for temporary fixation after reconstruction of bone defect in 10 cases [the length of bone defect was 6-19 cm (mean, 12.3 cm); using vascularized fibular graft in 2 cases, allograft bone and free fibular graft in 2 cases, allograft bone and autogenous bone graft in 5 cases, allograft bone reconstruction in 1 case]; bone distraction lengthening for limb length discrepancy in 5 cases [the length of shortening was 6.5-8.5 cm (mean, 7.5 cm)]; temporary fixation after open biopsy in 3 cases; bone transportation over locking plate in 1 case (the length of bone defect was 7.5 cm); fixation for preoperatively pathology fracture in 1 case; and joint distraction for dislocation after tumor ablation in 2 cases.
All the patients were followed up 12-72 months (mean, 36 months). In 10 patients with bone defect reconstruction, the wearing external fixator time was 3-8 months (mean, 4.8 months); all got bone union with the healing time of 3-16 months (mean, 6.4 months); the Musculoskeletal Tumor Society 93 (MSTS 93) score was 73.3-93.3 (mean, 87.2); and no complication occurred during wearing external fixator. In 5 patients with bone distraction lengthening for limb length discrepancy, the wearing external fixator time was 7-15 months; 2 patients had axial deviation during distraction and2 had greenstick fracture after apparatus removal; pin site infection was observed in 2 cases with grade 1 and 1 case with grade 2 according to Checketts-Otterburn classification system; the MSTS 93 score was 80.0-96.7 (mean, 89.2). The remaining patients had no complications, the knee and ankle joint movement was normal.
Orthofix unilateral external fixator can be used in fixation for complex bone defect after tumor resection and to correct limb length discrepancy after limb salvage surgery.
探讨Orthofix单侧外固定器治疗肌肉骨骼肿瘤的手术特点及初步疗效。
2011年6月至2016年3月，22例患者接受Orthofix单侧外固定器治疗，用于肿瘤切除后骨缺损或保肢手术后并发症。其中男性11例，女性11例，中位年龄23.5岁（范围4 - 57岁）。肿瘤切除后骨缺损或肢体长度差异位于股骨近端6例、股骨远端8例、股骨干3例、胫骨近端2例、胫骨干3例。10例骨缺损重建后使用外固定进行临时固定[骨缺损长度为6 - 19 cm（平均12.3 cm）；2例采用带血管腓骨移植，2例采用同种异体骨与游离腓骨移植，5例采用同种异体骨与自体骨移植，1例采用同种异体骨重建]；5例因肢体长度差异行骨延长术[缩短长度为6.5 - 8.5 cm（平均7.5 cm）]；3例开放活检后进行临时固定；1例通过锁定钢板行骨搬运（骨缺损长度为7.5 cm）；1例术前病理性骨折固定；2例肿瘤切除后关节脱位行关节牵张。
所有患者随访12 - 72个月（平均36个月）。10例骨缺损重建患者，外固定器佩戴时间为3 - 8个月（平均4.8个月）；均获得骨愈合，愈合时间为3 - 16个月（平均6.4个月）；肌肉骨骼肿瘤学会93（MSTS 93）评分73.3 - 93.3（平均87.2）；佩戴外固定器期间无并发症发生。5例因肢体长度差异行骨延长术患者，外固定器佩戴时间为7 - 15个月；2例在牵张过程中出现轴向偏移，2例拆除器械后发生青枝骨折；根据Checketts - Otterburn分类系统，2例发生1级针道感染，1例发生2级针道感染；MSTS 93评分80.0 - 96.7（平均89.2）。其余患者无并发症，膝关节及踝关节活动正常。
Orthofix单侧外固定器可用于肿瘤切除后复杂骨缺损的固定及保肢手术后肢体长度差异的矫正。
