Yu Li, Yu Guorong, Deng Kai, Wang Guorong
Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Medicine (Baltimore). 2019 Jan;98(3):e14031. doi: 10.1097/MD.0000000000014031.
Tibial hemimelia is known as a rare congenital lower limb deficiency. It has been classified into different types based on Jones classification, and the traditional treatment of tibial hemimelia is amputation. Here we present a variant and unclassified case of tibial hemimelia, which was caused by osteomyelitis. And the lower limb with tibial hemimelia was salvaged by asymmetric limb lengthening.
19-year-old girl had the shortened and curved left lower extremity with walking abnormalities.
The patient's deformity was caused by osteomyelitis of tibia occurred when she was 18 month old. The tibial shaft was absent, while the proximal and distal tibia was present but was hypoplastic with radiographic analysis. The fibula was hypertrophied and curved like the capital letter C. The leg length discrepancy (LLD), mostly coming from the left lower leg, was 22 cm.
We were able to salvage the limb successfully by 5 operations, including releasing soft tissue, fusing the proximal tibiofibular joint, fibular osteotomy, femur lengthening, and fibular lengthening.
The whole treatment time for the patient was 3 years and 2 months, and she was followed up for 5 years afterward. The length of femur lengthening and fibula lengthening during the reconstruction were 7.8 cm and 11 cm, respectively. Most of the deformities were corrected, except that the left lower limb was still 2 cm shorter than the contralateral limb, and the 34 mm of mechanical axis deviation (MAD) of left lower limb remained. The reason why the patient's lower limbs were asymmetric was that the femur and fibular lengthening were performed within the affected limb only. Overall, the patient was very satisfied with her asymmetric limbs and its function after surgeries.
The LLD in this case mainly came from tibial hemimelia. However, the fibula was unable to be lengthened to 22 cm during the lower leg distraction process because of blood flow disturbance. We could only lengthen the femur to salvage the limb in this situation. Even though the patient still had a few residual deformities and a pair of asymmetric lower limbs, she was satisfied with the function and appearance of the reconstructed limb. Therefore, the lower limb with tibial hemimelia can be salvaged by asymmetric limb lengthening in special cases.
胫骨半肢畸形是一种罕见的先天性下肢缺陷。根据琼斯分类法，它已被分为不同类型，传统的胫骨半肢畸形治疗方法是截肢。在此，我们报告一例由骨髓炎引起的变异且未分类的胫骨半肢畸形病例。通过不对称肢体延长术挽救了患有胫骨半肢畸形的下肢。
一名19岁女孩的左下肢缩短且弯曲，行走异常。
患者的畸形是由18个月大时发生的胫骨骨髓炎所致。经影像学分析，胫骨干缺失，而胫骨近端和远端存在但发育不全。腓骨肥大且弯曲成大写字母C形。肢体长度差异（LLD）主要来自左小腿，为22厘米。
我们通过5次手术成功挽救了该肢体，包括松解软组织、融合胫腓近端关节、腓骨截骨、股骨延长和腓骨延长。
患者的整个治疗时间为3年零2个月，之后进行了5年随访。重建过程中股骨延长和腓骨延长的长度分别为7.8厘米和11厘米。除左下肢仍比对侧肢体短2厘米以及左下肢存在34毫米的机械轴偏差（MAD）外，大部分畸形得到纠正。患者下肢不对称的原因是仅在患侧肢体上进行了股骨和腓骨延长。总体而言，患者对术后不对称的肢体及其功能非常满意。
该病例中的LLD主要源于胫骨半肢畸形。然而，在小腿牵张过程中，由于血流干扰，腓骨无法延长至22厘米。在这种情况下，我们只能延长股骨以挽救肢体。尽管患者仍有一些残留畸形和一对不对称的下肢，但她对重建肢体的功能和外观感到满意。因此，在特殊情况下，通过不对称肢体延长术可挽救患有胫骨半肢畸形的下肢。
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