应用Orthofix重建外固定架治疗骨缺损

目的 总结应用Orthofix重建外固定架分别利用骨运输术、一期清创 短缩肢体 截骨延长技术以及一期清创 短缩肢体 二期截骨延长技术治疗26例骨缺损的经验，探索肢体安全短缩的限度。方法 在患肢上安放Orthofix重建外固定架。对17例胫骨和2例股骨骨缺损5～22cm者行骨运输术。对5例胫骨干骨缺损小于5cm合并皮肤缺损及感染者和1例股骨干骨缺损4cm合并感染者行一期清创 短缩肢体 延长技术进行治疗。对2例胫骨缺损5cm和1例股骨干骨缺损4cm者合并感染的患者采用先一期清创 部分短缩肢体，术后继续短缩肢体，二期截骨延长恢复肢体的长度。截骨术后10～14d开始延长，每天4次，每天延长1mm。16例胫骨和2例股骨在远、近缺损端相遇后于骨缺损端行清创术和自体骨植骨术。结果 平均随访13个月。骨缺损均得以重建，患肢肢体长度完全恢复，骨折愈合，无感染复发。在5例使用一期清创 短缩 延长法的胫骨缺损和1例行一期短缩 延长法的股骨缺损患者中，3例胫骨和1例股骨短缩至4cm时出现血管危象，立即恢复1cm长度后肢体远端血运恢复。术后第3天开始继续短缩肢体，每天4mm，每天4次。1例术后出现腓总神经麻痹，术后2个月恢复。4例胫骨缺损患者诉膝部疼痛。3例胫骨缺损患者出现马蹄内翻足。2例胫骨缺损患者出现下胫腓分离。结论 应用Orthofix重建外固定架进行骨运输是治疗骨缺损的有效方法，谨慎使用短缩 延长技术。对于软组织有损伤的肢体一期短缩不应超过3cm，可以于术后第2天开始继续短缩，每天短缩4mm，每天4次，每次1mm。

Management of bone defects with Orthofix Limb Reconstruction System

Objective To introduce the experience of managing 26 cases of bone defect respectively with bone transport, one stage debridement shortening lengthening technique, and one stage debridement shortening second stage lengthening technique using Orthofix Limb Reconstruction System, and to discuss the safety limit for one stage limb shortening. Methods Orthofix Limb Reconstruction System was mounted on the involved bones. 17 tibias and 2 femurs with 5 to 22cm segmental bone defects were treated with bone transport. 5 tibias with 4 to 6 cm segmental bone defects and 1 femur with 4 cm bone defect combined with soft tissue defect and infection were managed with one stage shortening lengthening technique. 2 tibias with 5 cm segmental bone defects and soft tissue defect were shortened by 3 cm at stage one, and further shortened gradually afterwards. Osteotomy was performed at the second stage, and the length was restored by bone lengthening. 10 to 14 days after osteotomy, bone transport or bone lengthening commenced at a rate of 0.25mm 4 times a day. Debridement and autogenous bone grafting were performed at the docking site when two ends met in 16 tibias and 2 femurs. Results All the cases were followed up for 13 months on average. Bone defects were reconstructed and lengths were restored. All fractures healed without reoccurrence of infection. Vascular crisis occurred when 4cm had been shortened in 5 tibias and 1 femur with one stage shortening lengthening technique. Vascularity was recovered immediately after the bone was lengthened by 1 cm. From the third day on, shortening was continued at a rate of 1mm 4 times a day. There was 1 common peroneal nerve palsy that recovered 2 months later. 4 cases of tibial defect complained of knee pain, and 3 equinovarus deformity happened in 3 cases of tibial defect. Displacement at the distal tibial fibular syndesmosis happened in 2 cases of tibial defect. Conclusions Bone transport and bone lengthening with Orthofix Limb Reconstruction System is effective in the treatment of bone defects. Bone shortening at one stage can not exceed 3 cm in the extremity with soft tissue injury. Shortening can be continued at a rate of 1mm 4 times a day 3 days after operation.