Olesen Ulrik Kähler, Nygaard Tobias, Prince Daniel E, Gardner Matthew P, Singh Upender Martin, McNally Martin A, Green Connor J, Herzenberg John E
Rigshospitalet, Department of Orthopedic Surgery, Copenhagen Limb Lengthening and Bone Reconstruction Unit, Denmark (Dr. Kähler Olesen, Dr. Nygaard, and Dr. Singh); the Memorial Sloan Kettering Cancer Center, Orthopedic Service, New York City, NY (Dr. Prince); the Sinai Hospital, Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening, Baltimore, MD (Dr. Herzenberg); the Springfield Clinic, Springfield, IL (Dr. Gardner); the Nuffield Orthopedic Centre, Oxford University Hospitals, UK (Dr. McNally); and the Children's University Hospital, Dublin, Ireland (Dr. Green).
J Am Acad Orthop Surg Glob Res Rev. 2019 Aug 12;3(8):e064. doi: 10.5435/JAAOSGlobal-D-19-00064. eCollection 2019 Aug.
This article describes a new bone transport technique for femoral and tibial bone defects using lengthening nails combined with locking plates. We term it plate-assisted bone segment transport (PABST).
Nine patients with five femoral and four tibial bone defects from open fractures or malignancies were treated between 2016 and 2018. Mean femoral defect length was 9.3 cm (range 7 to 11.5). Mean tibial defect was 8.9 cm (range 4.8 to 15). The patients were evaluated for time to weight bearing, consolidation index, mechanical axis deviation, and limb length discrepancy.
Seven of nine patients have fully consolidated. The mean consolidation time was 6.6 months. The consolidation index was 0.9 (femur) and 1.26 (tibia) mo/cm. Two patients required supplementary lengthening. One patient had mild varus, one mild valgus; the remainder had a normal mechanical axis. Limb length discrepancy remained acceptable in all patients. The main complications were heterotopic ossification, delayed healing, and reduced knee motion.
Bone transport with lengthening nails and locking plates is an effective and patient-friendly way of treating bone defects, eliminating the adverse effects of external fixation and reducing treatment time. The plate provides stability during transport and docking; it can address concomitant fractures and facilitates acute shortenings.
本文介绍了一种使用延长钉结合锁定钢板治疗股骨和胫骨骨缺损的新骨搬运技术。我们将其称为钢板辅助骨段搬运（PABST）。
2016年至2018年间，对9例因开放性骨折或恶性肿瘤导致股骨和胫骨骨缺损的患者进行了治疗。股骨缺损平均长度为9.3厘米（范围7至11.5厘米）。胫骨缺损平均长度为8.9厘米（范围4.8至15厘米）。对患者进行负重时间、愈合指数、机械轴偏差和肢体长度差异的评估。
9例患者中有7例已完全愈合。平均愈合时间为6.6个月。愈合指数股骨为0.9，胫骨为1.26个月/厘米。2例患者需要补充延长。1例患者有轻度内翻，1例有轻度外翻；其余患者机械轴正常。所有患者的肢体长度差异均在可接受范围内。主要并发症为异位骨化、延迟愈合和膝关节活动度降低。
使用延长钉和锁定钢板进行骨搬运是一种治疗骨缺损的有效且对患者友好的方法，消除了外固定的不良影响并缩短了治疗时间。钢板在搬运和对接过程中提供稳定性；它可以处理合并骨折并便于急性缩短。
