KW组合式外固定骨延长器在下肢截骨延长及骨迁移中的应用

[目的]探讨一种新型的组合式外固定延长系统在肢体短缩畸形及骨缺损中应用的方法及治疗效果。[方法]在Hoffmann II型外固定器基础上,设计出新型的KW组合式外固定骨延长器,并治疗15例肢体短缩及骨缺损患者。肢体短缩者10例,平均短缩8.7 cm(6.0～22);外伤性骨骺损伤后遗症4例,骨髓炎后遗症所致下肢不等长3例,其中4例肢体延长同时行预防性跟腱延长术,1例合并足外翻畸形行胫距关节融合术矫正,3例合并膝内翻畸形,同期或先行膝内翻截骨矫形手术;3例脊髓灰质炎后遗症合并马蹄内翻足畸形,行三踝关节融合术矫正。应用骨迁移技术治疗骨缺损患者5例,平均骨缺损长度7.3 cm(5.0～8.5 cm),其中2例合并足下垂,延长同时行跟腱延长术矫正。[结果]所有患者均达到术前预定的肢体延长长度,下肢畸形得以矫正,骨缺损修复。平均延长或迁移7.5 cm(5.5～21 cm),平均外固定时间89 d(68～343 d);平均外固定指数16.3 d/cm(9.0～32.5 d/cm),平均骨愈合指数39 d/cm(30～62 d/cm)。[结论]KW组合式外固定骨延长器操作简单,是用于治疗肢体短缩畸形和骨缺损的理想器械。     

胫骨上下干骺端双截骨肢体延长术：附12例报告

胫骨上下干骺端双截骨肢体延长术（附１２例报告）李遇俊，李文广，于永林，郑继好，章秀清在胫骨干骺端肢体延长术的基础上，设计了胫骨上、下干骺端双截骨延长术，制作了延长固定架。自１９８８年１０月～１９９０年１０月共治疗１２例，效果良好。手术方法一、手术适应...     

胫骨不同部位截骨延长术的疗效比较

目的：比较胫骨不同部位截骨延长术的治疗效果。方法：分别应用胫骨干骺端截骨(20例)、骨干截骨(25例)和靠近骨端的骨干截骨(56例)实施小腿延长术，比较延长段骨痂生长速度、质量及术后并发症。结果：三种方法都能最终获得满意预期长度和自身愈合，其中干骺端延长骨生长速度最快，质量最好，近骨端骨干延长次之，骨干延长最慢。但干骺端延长并发症最多，程度最重。结论：小腿延长术以胫骨近端骨干截骨效果最好。     

胫骨干骺端截骨延长术的护理

胫骨干骺端截骨延长术是矫正下肢短缩畸形的有效方法,已广泛应用于临床。我院1989～1991年采用此法治疗小儿麻痹症后遗症15例,术后3～8个月骨愈合,胫骨延长2～6cm,疗效满意。临床资料与手术方法15例小儿麻痹症中,男9例,女6例,年龄12～30岁。一侧肢体短缩3～5cm3例,5～6cm8例,6～7cm4例。15例经胫骨干骺端截骨延长术。即在硬膜外麻醉下,截断腓骨,外踝做一小切口,1枚螺钉固定下胫腓关节。胫骨干与髌韧带上方约     

先天性腓骨缺如并发下肢不等长的治疗

目的：探讨先天性腓骨缺如合并下肢不等长的手术治疗。方法：采用胫骨干骺端截骨延长治疗２例先天性腓骨缺如肢体缩短患者。结果：２例病人胫骨分别延长４ｃｍ和１．５ｃｍ,胫骨前弓畸形矫正,但未达到双侧肢体等长。结论：先天性腓骨缺如和索带可能影响胫骨延长术的效果。     

先天性腓骨缺如并发下肢不等长的治疗(附2例报告)

目的　探讨先天性腓骨缺如合并下肢不等长的手术治疗。方法 :采用胫骨干骺端截骨延长治疗 2例先天性腓骨缺如肢体短缩患者。结果 :2例病人胫骨分别延长 4cm和 1 .5cm。胫骨前弓畸形矫正 ,但未达到双侧肢体等长。结论 :先天性腓骨缺如的纤维索带可能影响胫骨延长术的效果。     

胫骨不同部位截骨延长术的疗效比较

目的 比较胫骨不同部位截骨延长术的治疗效果。方法 分别应用胫骨干骺端截骨(20例)、骨干截骨(25例)和靠近骨端的骨干截骨(56例)实施小腿延长术,比较延长段骨痂生长速度、质量及术后并发症。结果 三种方法都能最终获得满意预期长度和自身愈合,其中干骺端延长骨生长速度最快,质量最好,近骨端骨干延长次之,骨干延长最慢。但干骺端延长并发症最多,程度最重。结论 小腿延长术以胫骨近端骨干截骨效果最好。     

胫骨近端延长术术式选择失误致髌骨脱位

儿麻后遗症致肢体短缩,常采用胫骨近端截骨延长术,未闭合骨骺者常行干骺端延长,而闭合后行胫骨近端截骨延长.自1985年6月～2004年6月行胫骨近端截骨延长术64例,1990年10月前,采用胫骨结节上截骨延长术17例,延长终结后,均出现髌骨不同程度的脱位,关节僵直,屈曲受限.1990年10月后采用胫骨结节下"V"型截骨47例,无并发髌骨脱位.     

双下肢同步延长术治疗软骨发育不全性侏儒症

双下肢延长术治疗软骨发育不全性侏儒患者是近年来开展的一项新的手术方法．从１９８４年６月～１９９２年１２月，我们采用自行设制的框式外固定架为３８例患者施行了双下肢延长术．其中男１７例，女２１例．年龄９～２１岁，平均１６岁．术前身高１０６～１４０ｃｍ，平均１２４ｃｍ．采用三种术式：下肢骨骺牵开１４例（２８个节段），胫骨干骺端截骨延长２０例（４０个节段），股骨转子下截骨延长４例（８个节段）．术后胫骨延长长度为４．５～２２ｃｍ，平均１４．５ｃｍ，延长率为原骨长度的２５％～１４７％，平均７５％．骨愈合时间１５０～４２１天，其中３２例平均１５３天获骨愈合．股骨延长９～１６ｃｍ，平均１２ｃｍ，延长率３２％～１２０％．骨愈合时间１４０～３９１天，平均２２０天．平均治疗时间３９１天（１８０～５７１天）．愈合指数：胫骨３２ｄ／ｃｍ，股骨３８ｄ／ｃｍ．并发症包括足下垂畸形８例（１６足），骨迟缓愈合１例．     

骨搬移治疗胫骨感染性骨不连

目的分析骨搬移治疗胫骨感染性骨不连的临床疗效。方法2002年10月至2007年10月采用胫骨感染骨端清创、重建外固定支架加压固定及胫骨干骺端截骨骨搬移治疗胫骨感染性骨不连、纠正肢体短缩畸形45例。结果45例胫骨感染均得到一期控制,软组织缺损创面消灭,4例出现钉道感染;44例骨折愈合,1例骨折端再次形成骨不连;39例双下肢长度基本恢复一致,6例仍有1．5～3cm肢体短缩畸形存在,1例因截骨端提前愈合使肢体未能达到预期长度;术后截骨端骨延长2～9cm,平均延长6cm,无血管及神经损伤的症状出现;术后外固定支架固定6～12个月,平均8个月,所有病例延长区新骨组织形成良好。结论采用骨搬移治疗胫骨感染性骨不连,能达到一次手术兼顾控制骨端感染、消灭皮肤创面、骨折端不需植骨达到骨性愈合及均衡肢体长度的临床治疗作用,是治疗胫骨感染性骨不连的理想方法。     

严重肢体不等长50例治疗效果

目的 提高严重肢体不等长的治疗效果,减少术后并发症。方法 治疗５０例患者,比较不同平面的骨干延长,不同截骨方式,不同延长速度和频率的疗效。结果 平均延长９．５ｃｍ,其中单段最长１６ｃｍ,分段最长１８ｃｍ。     

Simultaneous Limb Lengthening With Ankle Fusion Using an Internal Lengthening Nail

We reviewed 18 limbs in 17 patients who underwent ankle fusion with simultaneous tibial lengthening with a magnetic internal lengthening nail. All patients had preoperative limb length discrepancy (LLD) (mean 4.9 cm (2.6-7.6 cm)) with ankle deformity. The ankle was fused from medial or lateral approaches using screws/plate constructs placed adjacent to the retrograde Precise nail. Lengthening was carried out by a distal 1/3 tibial osteotomy. Clinical and radiographic measures were performed after a mean follow-up of 20 months (12-37 months). The mean amount of lengthening performed was 4 cm (1.8-7.2 cm). The final mean LLD was 1 cm (0.7-1.1 cm), which was statistically significant (p<0.01) as compared to preoperative. The foot was plantigrade in all cases. The mean foot rotation was 10° (5-15°) external, relative to the knee. At final follow-up all patients reported minimal to no pain, and all claimed to be walking more functionally than before surgery. Ankle fusion and limb lengthening was achieved in all cases. Combining both treatments by using an internal lengthening nail was very effective and avoided leaving patients with a dysfunctional LLD or of having a separate limb lengthening procedure. This is the first report of such a combined treatment of ankle fusion with internal tibial lengthening nail.     

Tibial lengthening and concomitant foot deformity correction in 14 patients with permanent deformity after poliomyelitis

Background In neuromuscular diseases, limb lengthening and foot deformity correction are associated with a high risk of complications associated with distraction callus and joint contracture. We have found no published articles of tibial lengthening and concomitant foot deformity correction using the Ilizarov method or traditional methods. To compare result of gradual distraction with triple arthrodesis for foot deformity combined with tibial lengthening, we investigated healing index and complications of two methods.

Patients and methods We reviewed 14 patients with permanent deformity after poliomyelitis who underwent tibial lengthening and concomitant foot deformity correction using the Ilizarov external fixator. Tibial lengthening over an intramedullary nail was performed in 3 patients and lengthening without a nail was performed in 11 patients.

Results The mean external fixation time was 6 (3.6- 10) months without nail and 1.6 (1.5-1.7) months with nail, whereas the mean healing index was 1.8 (0.8-3.1) months/cm without nail and 2 (1.8-2.3) months/cm with nail. Concomitant foot treatments included triple arthrodesis in 7 patients, pantalar arthrodesis in 2 patients with fiail ankle, and gradual foot frame distraction without bony foot procedures in 5 patients. Delayed consolidation and recurrent equinus contracture of the ankle requiring additional lengthening of the Achilles tendon were the most common bone and joint complications during tibial lengthening.

Interpretation The gradual foot frame distraction method was associated with major complications, such as recurrent foot deformity, joint luxation, and arthritis. We therefore recommend triple arthrodesis as a concomitant procedure during tibial lengthening     

One-step treatment for evolved Blount's disease: four cases and review of the literature

In infantile tibia vara, the presence of superomedial bridge and sloped plateau requires several problems to be addressed: correction of varus deformity and internal tibial torsion, prevention of recurrences, restoration of normal joint congruity, and prevention and correction of limb length discrepancy. Four patients were treated as follows: percutaneous epiphysiodesis of the superolateral tibia and proximal fibula, elevation osteotomy of the medial tibial plateau, osteotomy of the fibula, and dome-shaped metaphyseal osteotomy of the tibia, followed by progressive lengthening. Osteosynthesis was achieved by an Ilizarov frame (average 6 months). Latest follow-up (average 6 years 10 months) showed that all patients were satisfied, with normal limb length and alignment and correct articular surface congruence. Correction of limb alignment, restoration of joint surface congruity, prevention of recurrence, and treatment of limb length discrepancy are all dealt with in the same procedure.     

Ilizarov bone transport after massive tibial trauma: Case report

IntroductionThis is a case report of extreme lengthening of the tibia of about 14.5 cm using bone transport technique following road traffic accident trauma to the lower limbs. The management of the subsequent massive skeletal defects was challenging to orthopedic surgeons. Based on reported cases, the highest tibial lengthening was 22 cm using bifocal transport, while the highest unifocal tibial lengthening reached 14.5 cm.Case presentationA 20-year-old male driver was brought to the emergency department after a road traffic accident. The patient had a right Gustilo IIIA segmental open tibia fracture with bone loss and other severe injuries. The tibial defect was 14.5 cm and the patient was then admitted for Ilizarov application six months after the accident. Although this case was particularly complicated, full limb length was restored.DiscussionThe management of this case was directed to correct the deformities and achieve equal length of both limbs to restore the normal function. Several new techniques have been developed recently to fill large bone defects. Limb lengthening using bone transport technique by application of Ilizarov ring fixator has been suggested as the leading option in filling massive bone gaps.ConclusionThe use of bone transport technique using Ilizarov external rings has proved to be a minimally invasive and reliable method in managing massive bone defects. Accurate application of the Ilizarov frame and proper transport of the middle segment are important factors alleviating the risk for deviation of the transported segment. However, due to the need for regular follow-ups and monitoring, it demands high compliance from the patient to achieve optimal results.     

Lengthening osteotomy in the metaphysis and diaphysis. An experimental study in the ovine tibia

In 20 sheep, aged seven to eight months, a tibial lengthening osteotomy was performed to compare the process of repair of the metaphyseal and diaphyseal regions of the bone. Analogous to clinical lengthening, two frame configurations of a bilateral external fixation device were used to obtain adequate fixation of the bone segments in the metaphyseal and diaphyseal lengthening osteotomies. A daily distraction rate of 1 mm for 4.5 weeks yielded an average length increase of 2.6 cm (12.5%). After death at 4.5 weeks postdistraction, the elongated bones were tested mechanically with the contralateral tibiae as controls. No significant difference in relative torsional strength of the elongated tibiae was found between the two groups. Inferior mechanical stability of the bone segments in metaphyseal compared with diaphyseal lengthening (due to differences in frame rigidity and distribution of muscular moments) influenced healing to such an extent that any superior biologic, osteogenic potential in the metaphyseal bone region was nullified. With the clinical use of two configurations of a given external device necessary for fixation of the bone segments in a metaphyseal or diaphyseal lengthening osteotomy, the empirically accepted idea that metaphyseal healing is superior may not be correct.     

Tibial lengthening and concomitant foot deformity correction in 14 patients with permanent deformity after poliomyelitis

BACKGROUND: In neuromuscular diseases, limb lengthening and foot deformity correction are associated with a high risk of complications associated with distraction callus and joint contracture. We have found no published articles of tibial lengthening and concomitant foot deformity correction using the Ilizarov method or traditional methods. To compare result of gradual distraction with triple arthrodesis for foot deformity combined with tibial lengthening, we investigated healing index and complications of two methods. PATIENTS AND METHODS: We reviewed 14 patients with permanent deformity after poliomyelitis who underwent tibial lengthening and concomitant foot deformity correction using the Ilizarov external fixator. Tibial lengthening over an intramedullary nail was performed in 3 patients and lengthening without a nail was performed in 11 patients. RESULTS: The mean external fixation time was 6 (3.6-10) months without nail and 1.6 (1.5-1.7) months with nail, whereas the mean healing index was 1.8 (0.8-3.1) months/cm without nail and 2 (1.8-2.3) months/cm with nail. Concomitant foot treatments included triple arthrodesis in 7 patients, pantalar arthrodesis in 2 patients with flail ankle, and gradual foot frame distraction without bony foot procedures in 5 patients. Delayed consolidation and recurrent equinus contracture of the ankle requiring additional lengthening of the Achilles tendon were the most common bone and joint complications during tibial lengthening. INTERPRETATION: The gradual foot frame distraction method was associated with major complications, such as recurrent foot deformity, joint luxation, and arthritis. We therefore recommend triple arthrodesis as a concomitant procedure during tibial lengthening     

External skeletal compression fixation and lengthening for shortened limb with non-union and deformity

From Oct. 1982 to Dec. 1988, external skeletal compression fixator of half-ring sulcated type was used on 12 patients, aged 8 to 12, for treatment of shortened leg with non-union and bone defect, 7 of which were in tibia and 5 in femur. Scar tissue between fragment ends that interfered contact was cleared off for proper apposition and stability. 12 the non-union healed up in 4 to 6 months. In 5 patients with open epiphyses, distraction epiphysiolysis for lengthening was simultaneously performed in addition to compression at the non-union site; the lengths gained range from 4 to 13.5 cm, with an average of 9.8 cm. The lengthened region got repaired with in-growing bone in 5 to 10 months. In 7 patients with closed epiphyses; metamyseal osteotomy was done in combination for lengthening too; the lengths obtained were 3 to 16 cm, averaging 7.8 cm. The distraction gap was obliterated by in-growing bone in 4 to 16 months. In one case, metaphyseal osteotomy was performed on both ends of the tibia to get longer length to make up the tibial shaft defect of 8 cm; both non-union and lengthening segments healed up in 6 months. Neither neural nor vascular damage has occurred in any case, advantages and indications of the operation was discussed, and the surgical procedure was described.     

Locked intramedullary nailing. Its application to femoral and tibial axial, rotational, lengthening, and shortening osteotomies

Interlocking nailing is an alternative method of internal fixation following corrective osteotomies for malunions or after correction of leg length inequality. Of 13 osteotomies (six femoral, seven tibial) for angular or rotational malunion, all healed following dynamic locked nailing. Eleven were considered anatomic and two had mild residual deformity. One-stage femoral lengthening was performed in 17 patients. The preferred operative technique includes a long Z-shaped osteotomy, static interlocking nailing, primary cancellous bone grafts, and one or two supplemental screws at the osteotomy site to prevent shortening following dynamization. Thirteen complications developed following one-stage lengthening of the femur, which included significant loss of length in five patients, femoral nerve palsies in four patients, three deep infections, and one nonunion. Lengthening should not exceed 4.0 cm in the femur. The recommended technique of shortening osteotomy consists of resection of a cylindric segment of bone from the distal diaphyseal metaphyseal area. Shortening should not exceed 4.5 cm in the femur or 3.0 cm in the tibia. In ten patients who were shortened, all healed, but radiologic signs of union appeared very slowly in most cases.     

Outcome of limb reconstruction system in open tibial diaphyseal fractures

Background:Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS) in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously.Results:Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm). The mean duration of bone transport was 13 weeks (range 8-30 weeks) with a mean time for LRS in place was 44 weeks (range 24-51 weeks). The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks) with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25), good in 12% (3/25) and fair in 4% (1/25) with union in all except 2 patients, which showed poor results (8%) with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25), good in 8% (2/25), fair in 8% (2/25). Pin tract infection was seen in 5 cases, out of which 4 being superficial, which healed to dressings and antibiotics. One patient had a deep infection which required frame removal.Conclusion:Limb reconstruction system proved to be an effective modality of treatment in cases of open fractures of the tibia with bone loss as definite modality of treatment for damage control as well as for achieving union and lengthening, simultaneously, with the advantage of early union with attainment of limb length, simple surgical technique, minimal invasive, high patient compliance, easy wound management, lesser hospitalization and the lower rate of complications like infection, deformity or shortening.