Javed Shahzad, Ahmad Ashfaq, Aziz Amer
Orthopaedic and Spine Department, Lahore Medical & Dental College, Ghurki Trust Teaching Hospital, Lahore, Pakistan.
Lahore Medical & Dental College, Ghurki Trust Teaching Hospital, Jallo, Lahore, Pakistan.
J Taibah Univ Med Sci. 2017 Jun 12;12(5):418-423. doi: 10.1016/j.jtumed.2017.04.006. eCollection 2017 Oct.
Vascularized or non-vascularized fibula transport is a novel procedure for limb salvage but has been associated with high failure rates and complications. Ipsilateral medial fibular transport (IMFT) using Ilizarov apparatus is a modification of the procedure to prevent complications and increase success rate. This article presents the largest series of limb salvage for massive tibial bone loss in children due to pan-osteomyelitis by IMFT with Ilizarov apparatus.
A case series of 12 patients with a mean age of 12 (6-18) years is described. At the first stage of surgery, the excision of all dead bone was performed, and Ilizarov without traction apparatus was applied. In second stage, ipsilateral fibula is gradually transferred to tibial defect with the help of ilizarov olive wires. In the third stage, the freshening of docking sites of fibula to tibia was performed. The minimum follow up was of two years.
Hypertrophy of the transported fibula accompanied by full weight bearing and satisfactory joint motion occurred in all patients. Removal of sequestrated bone resulted in control of infection in 27.17 ± 7.76 days. Fibular transport took 16.58 ± 4.14 days. The length of tibial bone loss replaced by fibula was 9.50 ± 2.23 cm. The mean days required for union after freshening of the docking site was 76.58 ± 6.20 days.
Ilizarov frame for pan tibial osteomyelitis with bone excision and medial fibular transport works well for limb salvage in children.
带血管或不带血管的腓骨转移术是一种用于保肢的新手术，但与高失败率和并发症相关。使用伊里扎洛夫器械的同侧内侧腓骨转移术（IMFT）是该手术的一种改良方法，以预防并发症并提高成功率。本文介绍了使用伊里扎洛夫器械通过IMFT治疗儿童因全骨髓炎导致的大面积胫骨骨缺损的最大系列保肢病例。
描述了一组12例平均年龄为12岁（6 - 18岁）的病例。在手术的第一阶段，切除所有死骨，并应用无牵引装置的伊里扎洛夫器械。在第二阶段，借助伊里扎洛夫橄榄针将同侧腓骨逐渐转移至胫骨缺损处。在第三阶段，对腓骨与胫骨的对接部位进行清创。最短随访时间为两年。
所有患者均出现转移腓骨肥大，伴有完全负重和满意的关节活动。清除死骨后，感染在27.17±7.76天得到控制。腓骨转移耗时16.58±4.14天。腓骨替代胫骨骨缺损的长度为9.50±2.23厘米。对接部位清创后愈合所需的平均天数为76.58±6.20天。
用于全胫骨骨髓炎伴骨切除和内侧腓骨转移的伊里扎洛夫框架在儿童保肢方面效果良好。
