Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Kunming Medical University, 176 Qinnian Road, Wuhua District, Kunming, Yunnan, 650021, People's Republic of China.
Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Xi Shan District, Kunming, Yunnan, 650031, People's Republic of China.
BMC Musculoskelet Disord. 2019 Nov 20;20(1):555. doi: 10.1186/s12891-019-2927-z.
Bone transport is used for the treatment of extensive limb bone defects. The application of ring or unilateral external fixators combined with single or double corticotomy are well documented; however, there are few cases adopting a single corticotomy to repair bone defects > 24 cm.
The present case study describes an 18-year-old male, who was involved in a traffic accident and was diagnosed with open fracture of the right tibia. The patient received emergency surgery in a local hospital and was transferred to The Second People's Hospital of Yunnan for further treatment 3 months later. The patient was diagnosed with fracture nonunion and infection following admission. Complete debridement was performed three times to control the infection. The infection was resolved after 26 days and the 24.5 cm massive tibia defect remained the biggest challenge. The bone transport technique involving a unilateral external fixator and single corticotomy was employed to treat the bone defect. Docking site union was achieved and bone consolidation was complete 40 months after corticotomy. The external fixator was subsequently removed. The bone healing index was 1.6 months/cm. The Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) revealed a good functional and bone repair result. Similarly, Knee Society Score (KSS) yielded good result and the The Lower Extremity Functional Scale (LEFS) was 65. A total of 45 months after injury, the patient was able to walk painlessly without ambulatory assistive devices and resumed daily activities successfully. Eighteen months after the bone and soft tissue wound have healed, the SF-36 score was 86, and the LEFS was 70.
To the best of the authors' knowledge, the present study described the longest bone defect repair performed using bone transport with single level corticotomy.
骨搬运技术用于治疗广泛的肢体骨缺损。环形或单侧外固定架结合单皮质或双皮质切开术的应用已有充分的文献记载；然而，采用单皮质切开术修复>24cm 的骨缺损的病例较少。
本病例研究描述了一位 18 岁男性，因车祸致右胫骨开放性骨折。患者在当地医院接受了急诊手术，并在 3 个月后转至云南省第二人民医院进一步治疗。患者入院时被诊断为骨折不愈合合并感染。为了控制感染，共进行了 3 次彻底清创。26 天后感染得到控制，但 24.5cm 的巨大胫骨缺损仍然是最大的挑战。采用单侧外固定架和单皮质切开术的骨搬运技术来治疗骨缺损。截骨部位愈合，在截骨后 40 个月完成骨整合。随后拆除外固定架。骨愈合指数为 1.6 个月/cm。应用伊利扎罗夫（Ilizarov）方法的研究和应用协会（ASAMI）标准显示出良好的功能和骨修复结果。同样，膝关节协会评分（KSS）也取得了良好的结果，下肢功能量表（LEFS）评分为 65。损伤后 45 个月，患者无需助行器即可无痛行走，并成功恢复日常活动。骨和软组织伤口愈合后 18 个月，SF-36 评分为 86，LEFS 评分为 70。
据作者所知，本研究描述了使用单皮质切开术的骨搬运技术修复最长的骨缺损。
