Accadbled F, Thévenin Lemoine C, Poinsot E, Baron Trocellier T, Dauzere F, Sales de Gauzy J
Department of Orthopaedics, Children's Hospital, CHU de Toulouse, France.
J Child Orthop. 2019 Jun 1;13(3):324-329. doi: 10.1302/1863-2548.13.190016.
Bone reconstruction after malignant tumour of the lower limbs is a challenge. Our aim was to investigate the results of bone lengthening and transport using the Fitbone motorized lengthening nail.
Eight patients were included. Two patients had had a tumour involving soft tissue only without bone resection. In six patients, the initial bone defect was 15.5 cm (8 to 24). The first step of reconstruction had consisted of temporary fixation and a cement spacer. The second step had consisted of bone grafting in five patients. One patient was managed with bone transport. Eventually, five patients had a limb-length discrepancy (LLD) managed with bone lengthening only. Two patients had a LLD and a nonunion managed with bone transport and lengthening. Mean age at bone lengthening was 15.2 years (11 to 19). Mean follow-up was 30.5 months (10 to 48).
In all, 11 nails were implanted in eight patients (eight femurs, three tibias). Mean length gain per procedure was 54.5 mm (30 to 80). Mean healing index was 48.4 days per cm (22.6 to 85.7). The complication rate was 18%. In two cases we observed a loose locking screw, which was revised. In all cases the lengthening involved the short bone (femur or tibia). Mean Musculoskeletal Tumor Society (MSTS) score improved from 52.7 (16.6 to 73.3) to 79.9 (63.3 to 96.6).
Bone reconstruction using a motorized intramedullary nail stands as a safe and reliable alternative after malignant tumour. It allows biological reconstruction with satisfactory clinical and radiological outcome and low complication rate.
III.
下肢恶性肿瘤后的骨重建是一项挑战。我们的目的是研究使用Fitbone电动延长钉进行骨延长和骨搬运的结果。
纳入8例患者。2例患者仅软组织受累，未行骨切除。6例患者初始骨缺损为15.5 cm（8至24 cm）。重建的第一步包括临时固定和骨水泥间隔物。第二步，5例患者进行了骨移植。1例患者采用骨搬运治疗。最终，5例患者的肢体长度差异（LLD）仅通过骨延长进行处理。2例患者的LLD和骨不连采用骨搬运和延长治疗。骨延长时的平均年龄为15.2岁（11至19岁）。平均随访时间为30.5个月（10至48个月）。
8例患者共植入11枚钉子（8例股骨，3例胫骨）。每次手术的平均长度增加为54.5 mm（30至80 mm）。平均愈合指数为每厘米48.4天（22.6至85.7天）。并发症发生率为18%。2例观察到锁定螺钉松动，进行了翻修。所有病例的延长均涉及短骨（股骨或胫骨）。肌肉骨骼肿瘤学会（MSTS）平均评分从52.7（16.6至73.3）提高到79.9（63.3至96.6）。
使用电动髓内钉进行骨重建是恶性肿瘤后一种安全可靠的选择。它允许进行生物重建，临床和影像学结果令人满意，并发症发生率低。
III级。
