Bezsmertnyi Yurii Oleksiiovych, Veremii Oleg Andriyovych, Shevchuk Viktor Ivanovych, Bezsmertnyi Olexander Yuriyovych
Scientific Department, Scientific and Research Institute of Rehabilitation of National Pirogov Memorial Medical University, Vinnytsia, Ukraine.
Orthop Res Rev. 2025 Jan 7;17:9-20. doi: 10.2147/ORR.S504597. eCollection 2025.
The formation of a functional tibial stump after combat injuries with extensive tissue damage is sometimes difficult. We describe a case of reconstruction of the tibial stump after a mine-blast injury. In this case, the fibula was completely removed as a result of fracture, and the tibia was amputated at the border of the upper and middle thirds. To create a stable platform with a larger bearing surface area and reduce the load on the distal fossa, the Ilizarov method was used. For the first time, the area of the bearing surface of the tibia stump was increased by more than 2 times in the case of the removed fibula. Thanks to the original surgery technique, the mushroom shape of the stump end was also obtained for the first time. In the process of prosthetics, this geometry actually increases the bearing surface area and has advantages over the Ertl technique, where the cylindrical end of the stump due to muscle atrophy and thinning of the fibro-skin lining can lead to bursitis and even ulcers. The spherical shape of the stump end causes less soft tissue trauma, increases the load-bearing capacity and durability of the results. According to the data of the GaitRite system, the walking performance in the long-term period practically corresponded to that of a healthy person. The technique of the operation is described in detail, including petal decortication, two oblique corticotomies of the tibia, formation of bone and periosteum fragments, distraction. The result is a highly functional stump with the possibility of using end support and full prosthetics. The proposed technique can be used in reconstructive operations on the tibia and femur stumps.
在伴有广泛组织损伤的战伤后形成功能性胫骨残端有时很困难。我们描述一例地雷爆炸伤后胫骨残端重建的病例。在该病例中，腓骨因骨折被完全切除，胫骨在中上三分之一交界处被截肢。为了创建一个具有更大支撑表面积的稳定平台并减轻远端窝的负荷，采用了伊里扎洛夫方法。在腓骨被切除的情况下，首次将胫骨残端的支撑表面积增加了两倍多。由于采用了原始的手术技术，还首次获得了残端末端的蘑菇形状。在假肢安装过程中，这种几何形状实际上增加了支撑表面积，并且比埃特尔技术具有优势，在埃特尔技术中，由于肌肉萎缩和纤维皮肤衬里变薄，残端的圆柱形末端可能导致滑囊炎甚至溃疡。残端末端的球形形状造成的软组织创伤较小，增加了承重能力和结果的耐久性。根据步态分析系统的数据，长期的行走表现实际上与健康人相当。详细描述了手术技术，包括花瓣状去皮质、胫骨的两次斜行截骨、骨和骨膜碎片的形成、牵张。结果是形成了一个功能高度健全的残端，具备使用末端支撑和全假肢的可能性。所提出的技术可用于胫骨和股骨残端的重建手术。
