Khan Abdul Qayyum, Siddiqui Yasir Salam, Abbas Mazhar, Sabir Aamir Bin
Department of Orthopaedic Surgery, J. N. Medical College, Faculty of Medicine, AMU, Aligarh, UP, India.
J Clin Orthop Trauma. 2021 Apr 19;18:20-24. doi: 10.1016/j.jcot.2021.04.008. eCollection 2021 Jul.
Complex gap nonunion of tibia following open fractures and osteomyelitis with pathological fractures in children is a treatment challenge with unpredictable outcome. Treatment options available are bone transport bone grafting, induced membrane technique, allograft reconstruction and Huntington procedure (ipsilateral transposition of vascularized fibula). There is no consensus in the literature about which technique is optimal in the given situation. The purpose of the present study is to evaluate the role of Huntington procedure in the management of complex gap nonunion of tibia in paediatric patients.
Eighteen patients (11 males and 7 females) with a mean age of 8.4 years (range 3-12 years) having complex gap nonunion of tibia with an average bone defect of 6.6 cm (range 5-17 cm) were treated with Huntington procedure between June 2008 to December 2016. The mean follow-up was 4.3years (range 3.5-6 years).
Union was seen in all except one, with an average time to union being 11.5 weeks and13.8 weeks at proximal and distal tibio-fibular synostosis respectively. Revision plating was done in one patient with nonunion. Hypertrophy of fibula was seen in all patients. One patient developed 15° ankle varus and required corrective osteotomy. Ankle was fixed in equinus in three patients with a mean value of 13.3° (range 5°-25°). Lambrinaudi procedure was done to correct 25° fixed ankle equinus in one patient. Fixed flexion deformity of knee was seen in nine patients with a mean value of 9.7° (range 5°-20°). Two patients had iatrogenic foot drop; one recovered completely and one had only partial recovery. Shortening was seen in eight patients with a mean value of 3.5 cm (range 1-5 cm). At final evaluation 9 patients were very satisfied, 8 satisfied and 1 was dissatisfied.
Huntington procedure is a useful limb salvage surgery for complex gap nonunion of tibia in children. However; further improvements in the surgical technique are needed to increase the patient satisfaction by reducing the risk of complications.
儿童开放性骨折后胫骨复杂间隙性骨不连以及伴有病理性骨折的骨髓炎是一项治疗挑战，其预后难以预测。现有的治疗选择包括骨搬运植骨、诱导膜技术、同种异体骨重建以及亨廷顿手术（带血管蒂腓骨同侧转位）。对于在特定情况下哪种技术最为理想，文献中尚无共识。本研究的目的是评估亨廷顿手术在小儿患者胫骨复杂间隙性骨不连治疗中的作用。
2008年6月至2016年12月期间，对18例平均年龄8.4岁（范围3 - 12岁）的胫骨复杂间隙性骨不连患者（11例男性，7例女性）进行了亨廷顿手术治疗，平均骨缺损6.6厘米（范围5 - 17厘米）。平均随访时间为4.3年（范围3.5 - 6年）。
除1例患者外，其余均实现骨愈合，近端和远端胫腓关节融合的平均愈合时间分别为11.5周和13.8周。1例骨不连患者进行了翻修钢板固定。所有患者均出现腓骨肥大。1例患者出现15°内翻足，需要进行截骨矫正。3例患者踝关节呈马蹄足固定，平均角度为13.3°（范围5° - 25°）。1例患者因25°固定性马蹄足畸形接受了兰布林奥迪手术矫正。9例患者出现膝关节固定性屈曲畸形，平均角度为9.7°（范围5° - 20°）。2例患者出现医源性足下垂；1例完全恢复，1例仅部分恢复。8例患者出现肢体短缩，平均短缩3.5厘米（范围1 - 5厘米）。最终评估时，9例患者非常满意，8例满意，1例不满意。
亨廷顿手术是治疗儿童胫骨复杂间隙性骨不连的一种有效的保肢手术。然而，需要进一步改进手术技术，以通过降低并发症风险来提高患者满意度。
