Metacarpal lengthening by distraction histiogenesis in adults

Background:

Metacarpal lengthening in the hand is a new application for distraction neo-histiogenesis. Metacarpal lengthening with distraction helps in improvement in pinch function. Thumb lengthening is technically easy in comparison to other metacarpals. We present the operative treatment and post-operative outcome in nine patients with amputations and congenital anomalies.

Materials and Methods:

Nine patients underwent distraction osteogenesis for the treatment of amputations of the hand and other congenital anomalies. The dominant right hand was operated in eight cases and the left hand in one case. There were six males and three females. Improvement of function was always the aim of surgery. Age range was between 18 and 23 years. Thumb lengthening was performed in five patients and that of the index finger in four patients. Distraction started on the fifth post-operative day at the rate of 0.25 mm/day. Sensory function and bone consolidation was assessed before fixator removal.

Results:

The mean duration of distraction was 51 days (range, 42–60 days) and the distractor was removed at a mean of 150 days (range, 140 and 160 days) and the bones were lengthened by a mean of 24 mm (range, 20–28 mm) There was improvement of function in all cases.

Conclusion:

The metacarpal lengthening by distraction histiogenesis in congenital and traumatic amputations is safe and simple method to improve pinch function of hand.     

Preliminary experience with motorized distraction for tibial lengthening

Limb lengthening by callus distraction is commonly performed with the use of external fixation. Lengthening is routinely performed by the patient through small increments throughout the course of a day. Ilizarov has shown that both the rate and frequency of distraction are important factors in the quality of osteogenesis. We report the effect of motorized high frequency distraction for tibial lengthening in comparison with manual low-frequency distraction at the same rate. Manual distraction (0.25 mm four times a day) in a group containing 43 tibiae was compared with motorized distraction (1/1,440 mm 1,400 times a day) in a group containing 27 tibiae. There was no significant difference in time to union or in the incidence of complications.     

Limb lengthening by epiphyseal distraction

Summary Limb lengthening has been obtained using the technique of epiphyseal separation-distraction, initially in animal experiments and subsequently in operations on twenty-six human patients. The increase of length obtained ranged from 5–11 cm in the tibia and femur.There was no need for osteotomy, internal osteosynthesis, or bone grafting. The quality of the new bone formation was good and there have been no secondary fractures at the site of lengthening.

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Résumé Les auteurs ont réalisé l'allongement des membres inférieurs par une technique de «séparation-distraction épiphysaire», d'abord chez l'animal, puis chez l'homme. Vingt-six interventions ont été pratiquées. Le gain de longueur obtenu est compris entre 5 et 11 cm, tant au tibia qu'au fémur.Ce procédé ne nécessite ni ostéotomie, ni ostéosynthèse, ni greffe osseuse. L'os néoformé est de bonne qualité et il n'y a eu aucune fracture secondaire au niveau de l'allongement.

     

Mandibular lengthening by gradual distraction in humans

The purpose of this study was to evaluate human mandibular lengthening by gradual distraction. The operation was performed under nasoendotracheal anesthesia. After exposing the angle of the mandible through an intraoral incision, two half-pins were inserted on each side of the corticotomy line. Following this, a corticotomy was performed using a sagittal saw, and the mandible was gently fractured. The external bone lengthening device was applied leaving a bone gap of 3 mm. Serial distraction of 1 mm per day was started on the 10th postoperative day. The device was left in place for retention purposes for 9–11 weeks. Three patients (average age 10 years and 3 months) underwent this procedure. The distraction achieved was 19 mm. Postoperatively, improvement of facial asymmetry and increased volume and length of the mandible were noted without any perioperative complications. The follow-up period averaged 13 months. These results suggested that this procedure is beneficial for the treatment of craniofacial microsomia.     

下肢延长美容增高术

目的：研究应用肢体延长技术进行美容增高的安全性及效果，探索人体美容增高的方法。方法：应用改进后的经皮小切口骨延长技术，对60例成人矮身材志愿者行双下肢肢体延长，观察并记录延长区骨愈合，并发症，术后肢体功能恢复以及身体增高幅度。结果:60例术后身高增加5－10cm，平均增高6.8cm，延长率平均19.6%。延长区骨愈合时间为6－16个月，平均8．2个月。无严重并发症。随访2－8年，均能参加正常工作和学习，形态外观美容改善，心理障碍消除。骨愈合后2年以上的患者，均恢复跑，跳等大强度运动能力。结论：通过肢体延长进行增高是一种较为安全及有效的治疗方法。     

二处截骨骨搬移治疗胫骨大段骨缺损合并软组织缺损

目的 探讨二处截骨骨搬移治疗胫骨大段骨缺损合并软组织缺损的疗效及其加速骨和软组织愈合的可能性.方法 2009年5月至2011年5月共收治6例胫骨大段骨缺损合并软组织缺损患者,均为男性;年龄20～51岁,平均34.5岁.致伤原因:交通伤5例,机器压砸伤1例.均为Gustilo ⅢB型开放性骨折.小腿胫前软组织缺损面积为8cm ×4cm～24cm×11 cm,胫骨缺损长度为8～18cm.清创后采用半环槽外固定支架固定,胫骨上、下干骺端截骨骨搬移治疗骨缺损和软组织缺损.术后每侧截骨端骨搬移速度为1 mm/d,直至搬移骨折端对合,本组患者搬移所需时间为40～100 d,平均66.6 d. 结果 6例患者术后获10 ～ 36个月(平均16个月)随访.小腿软组织缺损愈合,骨缺损均获重建,4例患者双下肢等长,2例患肢肢体长度较健侧短缩1.5 cm.软组织愈合时间为60 ～ 180 d,平均103 d;骨愈合时间为12 ～31个月,平均19.3个月.所有患者牵拉结束后,未发现骨不连和骨痂愈合过快而无法继续牵拉成骨的现象,均不需要植骨. 结论 二处截骨骨搬移不但可有效治疗胫骨大段骨缺损合并软组织缺损,而且可加快骨搬移和软组织愈合的速度.     

外固定架尺骨延长治疗遗传性多发性骨软骨瘤所致前臂畸形

目的探讨采用外固定架尺骨延长治疗遗传性多发性骨软骨瘤(HMO)所致前臂畸形的疗效。方法回顾分析2014年4月至2018年4月北京积水潭医院创伤骨科采用外固定架尺骨延长治疗HMO所致前臂畸形患者5例。其中男4例,女1例;平均年龄14.5岁(12~16岁);右侧2例,左侧3例;MasadaⅠ型2例,MasadaⅡB型3例。5例患者均接受尺骨延长手术治疗。对3例MasadaⅡB型患者采用环形外固定架,另2例采用单边外固定架。1例合并桡骨骨折患者同时行桡骨骨折切开复位内固定术。截骨术后8~10 d开始行尺骨牵开延长。结果5例患者均获得随访,平均随访时间16个月(12~30个月)。3例MasadaⅡB型患者桡骨头均自行复位。5例患者尺骨平均延长37.5 mm(30~45 mm),平均应用外固定架时间162 d(122~274 d),平均外固定架指数48.9 d/cm。术前和术后平均梅奥肘关节评分分别为36.4分和92.7分,平均肘关节屈曲活动范围分别为118.0°(110°~130°)和130.0°(120°~150°),平均伸肘活动范围分别为12.7°(10°~20°)和3.5°(0°~10°),平均前臂旋前活动范围分别为18.6°(5°~30°)和44.7°(30°~65°),平均前臂旋后活动范围分别为71.2°(50°~85°)和86.5°(75°~90°)。1例桡骨干骨折患者术后3个月骨折愈合。2例出现针道感染;1例尺骨过早愈合,行第2次截骨手术后延长顺利。未见神经血管并发症。5例患者对治疗结果均满意。结论采用外固定架逐渐延长尺骨治疗HMO患者尺骨短缩畸形和桡骨头脱位安全有效。     

掌指骨延长的研究进展

目的总结掌指骨延长的研究进展,探讨存在的问题及进一步研究方向。方法查阅近年国内外关于掌指骨延长的文献,并进行总结分析。结果目前有多种方法治疗手指短缩畸形,掌指骨延长法相对占优势。它包括一次性骨延长、骨痂延长、缓慢牵伸延长3种,每种方法均有优势和局限。但在截骨部位、延长长度及速度以及术后并发症等方面尚存争议。结论相对于一次性骨延长和骨痂延长术,缓慢牵伸延长术创伤小、并发症少,但远期疗效尚不明确,还需要长期临床随访观察。     

Limb lengthening by diaphyseal corticotomy, callus distraction, and dynamic axial fixation. An experimental study in the ovine femur

Limb lengthening of the left femur was performed in 12 sheep, 7-8 months of age. After weakening of the cortex by drill holes, a controlled fracture was created in the diaphysis. The bone segments were fixed in reduced position using a unilateral external fixation device. The fixator was left in neutral position for 10 days postoperatively when lengthening started. By means of daily distraction at a rate of 1.0 mm once a day for 3 weeks, an average lengthening of 1.9 cm (11.9%) was obtained. Two weeks after distraction had been discontinued, distinct callus bridging of the lengthening zone was confirmed radiographically in all animals. At this time the rigid state of fixation was converted to a system allowing axial compression by loading in half the animals. The other half of the animals served as controls with the fixator remaining unchanged. The external device was left on until 5 weeks after the end of distraction. At this time the animals were killed. Both femora of all animals were tested mechanically in torsion. The average ultimate torsional strength of the elongated femur compared with control was 71% in the group with dynamic axial fixation and 65% in the control group. No significant difference in relative strength of the tested bones in the two groups was found. We conclude that intermittent axial compression by loading during consolidation had no significant effect on the bone-healing process evaluated by radiography and mechanical testing.     

足外侧柱延长术的基础及临床研究进展

目的综述足外侧柱延长术(lateral column lengthening,LCL)的基础及临床研究进展。方法广泛查阅近年国内外LCL相关文献,并对其进行分析。结果 LCL作为治疗平足畸形的重要手术方式之一,包括两种术式——跟骨远端截骨延长术和跟骰关节撑开融合术,目前在治疗平足畸形时具体术式选择尚存在争议。结论 LCL临床广泛用于治疗平足畸形,但需要生物力学试验和大样本临床随访结果进一步验证疗效。     

The influence of callus distraction on the growth plate

Objectives This study was designed to investigate the morphology, thickness and cellularity of the growth plate during callus distraction performed in the immediate vicinity of the growth plate. Methods Lengthening of the right tibia by 25% was carried out on 24 beagle dogs by callus distraction. Distraction was started at the fifth postoperative day with a distraction rate of 0.5 mm twice a day. A control group of six dogs underwent tibial osteotomy and external fixation without distraction. Half of the dogs of both groups were sacrificed at the end of the distraction phase of 25 days (Group A) and the remaining 15 dogs after an additional consolidation period of 25 days (Group B). The tibia and femur was removed from the distracted right leg and from the left control side of each animal and longitudinal sections were cut and stained with Pentachrome. The thickness and cellularity of the regeneration zone, the proliferation zone and the hypertrophic zone were determined for the proximal tibial and the distal femoral epiphysis. Results During the distraction phase the thickness of the proximal tibial growth plate and its cellularity were reduced on the distraction side. During the consolidation phase there was a slight recovery in the proximal tibial growth plate. Conclusions Callus distraction leads to a temporary reduction in growth of the affected physis.     

Bone Transport for Reconstruction in Benign Bone Tumors

Background

The aim of this study was to assess the results of using the Ilizarov apparatus to transport bones in the treatment of benign bone tumors.

Methods

Seven patients (six males and one female) with benign bone tumors were treated by bone transport with an Ilizarov apparatus at our institution. Their mean age at surgery was 14.4 years (range, 4.8 to 36.9 years). The histological diagnoses were osteofibrous dysplasia (4), giant-cell tumor (1), intraosseous cavernous hemangioma (1), and aneurysmal bone cyst (1). Three radiological indices were used for evaluating the results: an external fixation index, a distraction index, and a maturation index. The bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov classification.

Results

Five patients had bone union at the reconstructed site, one patient had a local recurrence, and the other had a nonunion at the docking site. The mean length of distraction was 7.3 cm (range, 5.1 to 12.1 cm). The mean external fixation index was 26.0 day/cm (range, 19.8 to 32.5 day/cm), the distraction index was 9.6 day/cm (range, 6.8 to 12.0 day/cm), and the maturation index was 14.9 day/cm (range, 8.0 to 22.5 day/cm). Ultimately, the bone and the functional results were rated excellent in six cases and good in one case.

Conclusions

Bone transport using the Ilizarov apparatus is a good treatment option in patients with bone defects after the resection of an active or aggressive benign bone tumor.     

外固定骨延长术在下肢骨肿瘤外科治疗中的应用

目的 探讨下肢骨肿瘤保肢手术的新方法以提高患者的生活质量。方法 （１）８例患者中,４例高分化骨肉瘤,手术前后给均予正规化疗;２例骨巨细胞瘤和２例骨母细胞瘤未化疗。（２）所有病例均按Ｅｎｎｅｋｉｎｇ诊断分级标准分级。首先完整切除肿瘤,然后同期应用半环式外固定架在骨缺损处行加压融合,在胫骨的干骺端截骨处行骨闸缓慢牵伸延长术,重建下肢功能。结果 行正规化疗的４例高分化骨肉瘤患者术后存活２９￣４８个月,保     

Bone lengthening osteogenesis,a combination of intramembranous and endochondral ossification: an experimental study in sheep

We evaluated the morphological features of the newly formed tissue in an experimental model of tibial callotasis lengthening on 24 lambs, aged from 2 to 3 months at the time of operation. A unilateral external fixator prototype Monotube Triax^® (Stryker Howmedica Osteonics, New Jersey) was applied to the left tibia. A percutaneous osteotomy was performed in a minimally traumatic manner using a chisel. Lengthening was started 7 days after surgery and was continued to 30 mm. The 24 animals were randomly divided into three groups of 8 animals each: in Group 1, lengthening took place at a rate of 1 mm/day for 30 days; in Group 2, at a rate of 2 mm/day for 15 days; in Group 3, at a rate of 3 mm/day for 10 days. In each group, 4 animals were killed 2 weeks after end of lengthening, and the other 4 animals at 4 weeks after end of lengthening. To assess bony formation in the distraction area, radiographs were taken every 2 weeks from the day of surgery. To study the process of vascularization, we used Spalteholz’s technique. After killing, the tibia of each animal was harvested, and sections were stained with hematoxylin and eosin, Masson’s trichrome, and Safranin-O. Immunohistochemistry was performed, using specific antibodies to detect collagens I and II, S100 protein, and fibronectin. A combination of intramembranous and endochondral ossification occurred together at the site of distraction. Our study provides a detailed structural characterization of the newly formed tissue in an experimental model of tibial lengthening in sheep and may be useful for further investigations on callotasis.     

Comparison between lengthening over nail and conventional Ilizarov lengthening: a prospective randomized clinical study

The aim of this study is to compare lengthening over an intramedullary nail to the conventional Ilizarov method with regard to percentage length increase, external fixation index, consolidation index and incidence of complications. This is a prospective randomized controlled study. Thirty-one limbs in 28 patients were included in the study; 15 were lengthened over an intramedullary nail, and 16 limbs were lengthened conventionally. The mean duration of external fixation in the lengthening over nail group was 52.2 days compared to 180.4 days in the conventional group. There was higher incidence of complications in the conventional method group. In comparison with conventional Ilizarov lengthening, lengthening over an intramedullary nail offers a shorter period of external fixation and fewer complications overall, but there is a high incidence of deep intramedullary infection which is serious.     

外固定架及重组合异种骨植骨治疗胫骨骨缺损与骨不连

目的：探讨外固定架和重组合异种骨(RBX)植骨治疗胫骨骨缺损、伴肢体短缩的胫骨骨不连及先天性胫骨假关节的临床疗效。方法：应用外固定架共治疗胫骨骨缺损、伴肢体短缩性骨不连及先天性胫骨假关节20例。胫骨断端清理后短缩长度2—9cm，平均4．8cm。断端应用RBX植骨12例。结果：20例病人随访8个月-7年，平均4年3个月，患肢功能恢复满意。12例应用RBX植骨治疗骨不连的平均愈合时间4．8个月。结论：本手术方法治疗胫骨骨缺损、伴肢体短缩的胫骨骨不连及先天性胫骨假关节，创伤小、操作简单，肢体功能恢复满意；RBX植骨治疗骨不连，安全，对促进骨愈合疗效可靠。     

Changes of osteocalcin and IGF-I during bone lengthening

Bonelengtheningisamuchmorecomplexprocesscomparedwiththeprocessoffracturehealing.Inthisprocessbonechangesinvariousaspects,morphologicallyandphysico chemically,andat differentintervalsanddifferentlevelsoflengthening, fromgrosstoultrastructural.Themajorityofstudies havebeenfocusedonclinicalorhistologicalchanges andmorphologicalaspects.Essentiallywehavenot paidmuchattentioninascertainingthechanges,ifit hasany,whichoccurinbasicphysicalandchemical parametersofboneatdifferenttimeorregion.As evidences…     

电磁场促进下肢美容增高区骨愈合的临床观察

目的　研究脉冲电磁场刺激对美容增高骨延长区成骨的影响 ,寻求促进病人康复的有效治疗手段。方法　 30例双下肢延长美容增高志愿者 ,随机分为脉冲电磁场治疗组和对照组 ,每组15例 ,治疗组在术后第 2天给予脉冲电磁场刺激。术后定期复查X线片 ,采用平均延长指数评价延长区骨愈合。结果　术后身高增加 5～ 9cm ,平均增高 (6 .6± 1.2 )cm ,延长率平均 19.2 %。其中 ,治疗组分别延长 5～ 8cm ,平均延长长度为 (6 .2± 1.1)cm ;对照组分别延长 5 .2～ 9cm ,平均延长长度为 (6 .8± 1.6 )cm。治疗组肢体水肿消退时间 (10 .4± 2 .6 )d ,对照组为 (16 .3± 3.6 )d。治疗组平均延长指数为 (32 .82± 2 .76 )d/cm ,对照组为 (39.6 6± 3.86 )d/cm ,经t检验 ,其结果差异具有显著性意义 (P <0 .0 5 )。结论　脉冲电磁场刺激能促进骨延长区新骨的生成与成熟 ,促进延长区骨愈合 ,可作为加速美容增高病人康复的辅助治疗手段。     

一期原位骨延长技术治疗四肢火器伤骨缺损的研究

目的　探讨四肢火器伤骨缺损的治疗方法和一期原位骨延长技术的生物学基础。　方法　对犬肢体火器伤骨缺损模型分别采用一期原位骨延长和传统的后期骨移植两种方法治疗,比较其骨愈合的病理过程及局部微循环血流量的变化。　结果　两组动物骨折局部血流量无显著差别。一期原位骨延长组８ 周内骨延长长度为２８２ ±０９４ ｃｍ , 相对长度为１９３ ％ （１５８ ％ ～２１４ ％ ） 。其骨愈合时间明显比后期植骨组短,伤肢功能也较好。软骨内化骨是骨延长过程中主要的成骨形式。　结论　一期原位骨延长技术治疗火器伤骨缺损,在缩短疗程,简化操作等方面具有明显优越性,且对火器伤骨折的愈合过程和局部血液循环无明显不良影响。