Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6, M. Ulianova Street, Kurgan, 640014, Russian Federation.
Int Orthop. 2019 May;43(5):1051-1059. doi: 10.1007/s00264-018-4032-6. Epub 2018 Jun 23.
Ilizarov bone transport for large bone defect is challenging and may end in distraction osteogenesis failure.
Ten forearm and seven tibial defect cases with failed regeneration due to ischaemia during bone transport were studied retrospectively. Mean forearm and tibial defects were 5.5 ± 0.8 and 7.6 ± 1 cm respectively, or 22.3 ± 3.6 and 20 ± 2.3% as compared with healthy segments. Most patients had numerous previous operations (2.6 ± 0.5 and 3.4 ± 0.8 per patient, respectively), extensive scars locally and post-traumatic neuropathy. There were seven infected defects. Mechanical solutions used were (1) additional osteotomy and transport of the fragment to compact the ischaemic regenerate (10 forearms, 4 tibias) and (2) compaction of the connective tissue layer in the tibial regenerate with either two 5-mm steps (two cases) or gradually (one case).
Bone integrity was restored in all the cases. Complete compensation of the defects was achieved in 12 patients with the first technique. Two patients with 8-cm ulna defects remained with residual discrepancy. In the forearm, mean compaction was 1.7 ± 0.4 cm. It took 25.7 ± 5.4 days followed by an average fixation period of 107.1 ± 11.8 days. In the tibia, mean longitudinal compaction by distraction measured 1.7 ± 0.8 cm. The second technique ended up with an acceptable shortening of 1 cm in two cases. Four centimeters were compressed in the third case gradually.
The technical solutions used for mechanical effects on the ischaemic distraction regenerate resulted in its rescue and bone union in all the cases.
伊里扎洛夫骨搬运治疗大骨缺损具有挑战性，可能导致骨搬运再生失败。
回顾性研究了 10 例前臂和 7 例胫骨因骨搬运过程中缺血导致再生失败的骨缺损病例。平均前臂和胫骨缺损分别为 5.5±0.8cm 和 7.6±1cm，或与健康段相比分别为 22.3±3.6%和 20±2.3%。大多数患者有多次手术史（分别为 2.6±0.5 次和 3.4±0.8 次），局部广泛疤痕和创伤后神经病变。有 7 例感染性缺损。使用的机械解决方案包括：（1）额外的截骨和骨块搬运以压缩缺血性再生骨（10 例前臂，4 例胫骨）；（2）用两个 5mm 步骤（2 例）或逐渐（1 例）压缩胫骨再生骨中的结缔组织层。
所有病例的骨完整性均得到恢复。12 例患者采用第一种技术完全补偿了缺陷。2 例尺骨 8cm 缺损患者仍有残余差异。在前臂，平均压缩量为 1.7±0.4cm，随后固定时间为 25.7±5.4 天，平均固定时间为 107.1±11.8 天。在胫骨中，通过牵引测量的纵向平均压缩量为 1.7±0.8cm。第二种技术最终在 2 例中导致可接受的 1cm 缩短。第三例逐渐压缩了 4cm。
用于缺血性骨搬运再生骨的机械效应的技术解决方案导致所有病例均成功挽救并实现骨愈合。
