Hessmann M, Rommens P M, Hainson K
Klinik für Unfallchirurgie, Johannes-Gutenberg-Universität, Mainz.
Unfallchirurg. 1998 May;101(5):370-6. doi: 10.1007/s001130050282.
In a 4-year period, 18 patients underwent callus distraction of the femur or tibia with the use of a unilateral external fixator. Twelve patients had post-traumatic bone loss resulting from complex lower-limb fractures. The bony defect was located in the tibia in 11 cases and in the femur in one case. All patients had major associated soft-tissue lesions. The length of the bony defect averaged 6.25 cm. Eight fractures were infected at the beginning of treatment. Six other patients underwent callus distraction for reasons of limb shortening. Five femora and one tibia were lengthened. The average increase in length was 6.5 cm. There were no fixator-related complications during distraction. The rate for the lengthening and consolidation phase was 49 days for 1 cm of length. Complications consisted of angulatory deformities in 6 cases, infections in four cases, fractures at the docking site in four cases and a fracture of the callotasis in one case. Nine patients underwent reosteosynthesis: planned secondary nailing after callus distraction was carried out in six patients. Three patients underwent plating at the docking site. The follow-up examination after bone transport showed a good-to-excellent outcome in 7 out of 11 patients. The outcome was satisfactory in 4 cases. Results after limb lengthening were good to excellent in all cases. The unilateral external fixator is, in our opinion, a convenient stabilization device and permits appropriate bone transportation for distraction osteogenesis. Alignment control during distraction, however, was difficult to manage in some cases. At the time of docking, reosteosynthesis by intramedullary nailing represents a viable alternative for further external fixation if the limb is free of infection.
在4年期间，18例患者使用单侧外固定器对股骨或胫骨进行骨痂牵张。12例患者因下肢复杂骨折导致创伤后骨缺损。骨缺损位于胫骨11例，位于股骨1例。所有患者均伴有严重的软组织损伤。骨缺损长度平均为6.25 cm。8例骨折在治疗开始时存在感染。另外6例患者因肢体短缩而行骨痂牵张。5例股骨和1例胫骨被延长。平均延长长度为6.5 cm。牵张过程中未出现与固定器相关的并发症。延长和骨愈合阶段每延长1 cm的时间为49天。并发症包括6例成角畸形、4例感染、4例对接部位骨折和1例骨痂牵张骨折。9例患者接受了再次骨固定术：6例患者在骨痂牵张后计划进行二期髓内钉固定。3例患者在对接部位进行了钢板固定。骨搬运后的随访检查显示，11例患者中有7例结果良好至优秀。4例结果满意。所有病例肢体延长后的结果均良好至优秀。我们认为，单侧外固定器是一种方便的稳定装置，可允许进行适当的骨搬运以实现牵张成骨。然而，在某些情况下，牵张过程中的对线控制难以管理。对接时，如果肢体无感染，髓内钉再次骨固定术是进一步外固定的可行替代方法。
