Children's Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital of Muenster, Muenster, Germany.
General Orthopaedics and Tumour Orthopaedics, University Hospital of Muenster, Muenster, Germany.
Bone Joint J. 2020 Sep;102-B(9):1248-1255. doi: 10.1302/0301-620X.102B9.BJJ-2019-1484.R1.
The treatment of tibial aplasia is controversial. Amputation represents the gold standard with good functional results, but is frequently refused by the families. In these patients, treatment with reconstructive limb salvage can be considered. Due to the complexity of the deformity, this remains challenging and should be staged. The present study evaluated the role of femoro-pedal distraction using a circular external fixator in reconstructive treatment of tibial aplasia. The purpose of femoro-pedal distraction is to realign the limb and achieve soft tissue lengthening to allow subsequent reconstructive surgery.
This was a retrospective study involving ten patients (12 limbs) with tibial aplasia, who underwent staged reconstruction. During the first operation a circular hexapod external fixator was applied and femoro-pedal distraction was undertaken over several months. Subsequent surgery included reconstruction of the knee joint and alignment of the foot.
The mean follow-up was 7.1 years (2 to 10). The mean age of the patients at the time of the application of the fixator was 2.3 years (1.1 to 5.0). The mean time under distraction was 139.7 days (81.0 to 177.0). A mean fibular distalization of 38.7 mm (14.0 to 67.0) was achieved. Pin infections occurred in four limbs (33.3%) and osteitis in one. A femoral fracture occurred in one patient. Premature removal of the frame was not required in any patient. Sufficient realignment of the leg as well as soft tissue lengthening was achieved in all patients, allowing subsequent reconstruction. All patients were able to mobilize fully weight bearing after reconstruction. Functional outcome was limited in all limbs, and five patients (50.0%) required additional reconstructive operations.
Regarding the functional results in the treatment of tibial aplasia, amputation remains superior to limb salvage. The latter procedure should only be performed in patients whose parents refuse amputation. Femoro-pedal distraction efficiently prepares the limb by realigning the leg and soft tissue lengthening. Minor complications are frequent, but usually do not hinder the continuation of distraction. Even though a fully weight-bearing limb is achieved, the functional outcome of reconstructive treatment remains limited. Recurrent deformities frequently occur and may require further operations. Cite this article: 2020;102-B(9):1248-1255.
胫骨发育不全的治疗存在争议。截肢术代表了功能效果良好的金标准，但常被患者家属拒绝。在这些患者中，可以考虑采用重建保肢治疗。由于畸形的复杂性，这仍然具有挑战性，并且应分期进行。本研究评估了环形外固定架股骨-踝部牵伸在胫骨发育不全重建治疗中的作用。股骨-踝部牵伸的目的是重新排列肢体并实现软组织延长，以允许随后进行重建手术。
这是一项回顾性研究，涉及 10 名（12 侧）胫骨发育不全患者，他们接受了分期重建。在第一次手术中，应用了环形六足外固定架，并进行了数月的股骨-踝部牵伸。随后的手术包括膝关节重建和足的对线。
平均随访时间为 7.1 年（2 至 10 年）。应用固定架时患者的平均年龄为 2.3 岁（1.1 至 5.0 岁）。平均牵伸时间为 139.7 天（81.0 至 177.0 天）。平均腓骨远端移位 38.7 毫米（14.0 至 67.0 毫米）。4 侧（33.3%）发生针道感染，1 侧发生骨髓炎。1 例患者发生股骨干骨折。无患者需要提前拆除外固定架。所有患者均能充分负重活动。所有患者均能实现充分负重活动。所有患者均能实现下肢充分对线和软组织延长，从而允许随后进行重建。所有患者在重建后都能够完全负重活动。所有肢体的功能结果均受限，5 例患者（50.0%）需要进一步的重建手术。
就胫骨发育不全的治疗功能结果而言，截肢术仍优于保肢术。后者仅应在患儿父母拒绝截肢术的情况下进行。股骨-踝部牵伸通过重新排列肢体和软组织延长有效地准备肢体。轻微并发症很常见，但通常不会妨碍牵伸的继续进行。尽管获得了可完全负重的肢体，但重建治疗的功能结果仍有限。复发性畸形经常发生，可能需要进一步手术。
2020;102-B(9):1248-1255.
