Growth factors in human serum during operative tibial lengthening with the ilizarov method

Despite the widespread clinical use of distraction osteogenesis for limb lengthening, the cellular and molecular mechanisms by which this surgical treatment promotes new bone formation in humans are not well understood. The aim of the research was to study the levels of growth factors (GFs) in the serum of patients that were undergoing tibial lengthening with the Ilizarov method of distraction osteogenesis. Those were patients with unilateral congenital discrepancy of the tibia (n = 12), unilateral posttraumatic tibial shortening (n = 7), and healthy patients that underwent cosmetic bilateral tibial lengthening (n = 10). The study established that unlike the congenital group, the posttraumatic group and healthy subjects showed a significantly evident increase in the levels of angiogenic GFs in their serum on day 10 of distraction. In the congenital group, the changes were not significant at this time point. The levels of TGF‐α, TGF‐β1, and TGF‐β2 tended to decrease on day 10 of distraction and on day 30 of the post‐distraction period in the cosmetic and posttraumatic groups while they grew in the congenital group. Most dynamic changes in the GFs levels during tibial lengthening were noted in the subjects undergoing cosmetic lengthening, and the least ones were in the congenital group. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1966–1970, 2013     

The Mechanics of External Fixation

External fixation has evolved from being used primarily as a last resort fixation method to becoming a main stream technique used to treat a myriad of bone and soft tissue pathologies. Techniques in limb reconstruction continue to advance largely as a result of the use of these external devices. A thorough understanding of the biomechanical principles of external fixation is useful for all orthopedic surgeons as most will have to occasionally mount a fixator throughout their career. In this review, various types of external fixators and their common clinical applications are described with a focus on unilateral and circular frames. The biomechanical principles that govern bony and fixator stability are reviewed as well as the recommended techniques for applying external fixators to maximize stability. Additionally, we have illustrated methods for managing patients while they are in the external frames to facilitate function and shorten treatment duration.     

模拟一次加压延长治疗先天性胫骨假关节胫骨前肌的变化

目的：研究在一次加压延长治疗先天性胫骨假关节过程中由大幅度肢体延长所带来的肌肉组织损害问题。方法：将２０只绵羊分成３个实验组，在胫骨下段分别切除胫骨全长的１０％ 、２０％ 和３０％ ，模拟制成切除先天性胫骨假关节后形成的大块骨缺损模型，断端少量髓芯植骨，利用自制改良 Ｉｌｉｚａｒｏｖ 外固定器械加压固定，在下段形成软组织堆积，干骺端－ 骨干部截骨延长，取径骨前肌标本，以肌纤维大小变化、肌纤维细胞核的内在化、肌纤维变性、再生、纤维化为基准，建立相应的组织病理学评分标准系统，研究各项参数的变化规律。结果：１０％ 组仅出现肌纤维大小的显著变化，而２０％ 、３０％ 组出现了反映不可逆损害的肌纤维细胞核内在化、肌纤维变性、肌纤维再生，肌纤维内膜纤维化等参数的显著变化。结论：骨延长超过一定限度，以常规１０ ｍ ｍ ／ｄ，４次／ｄ 速率，即使下段有软组织堆积的情况下，同样也不能缓解上段因超限延长所带来的肌肉组织不可逆性损害。     

运用双能X线骨密度仪观察下肢延长过程中新生骨痂BMD的变化

为探讨运用双能X线骨密度仪（DEXA）动态观察下肢股骨或胫骨骨痂牵拉延长矿化过程的临床价值，本文对27例下肢延长术患者在术后牵引期及骨痂生长期股骨或胫骨新生骨痂的骨密度（BMD）进行检测，并将截骨间隙处中心及边缘骨质分为7个兴趣区（ROI）加以分析。结果显示，在牵引的第4周，新生骨痂达到峰值；而牵引第8周（术侧肢体处于最大牵引长度时），BMD降至最低。骨延长停止后，BMD又逐渐上升，直到术肢外固定器去除。此外，靠近下肢延长固定器侧兴趣区内的骨闸新生量低于对侧。表明DEXA能对下肢延长期间新生骨痂进行量化测定，有助于临床监测肢体延长过程中骨愈合的状况。     

Ilizarov外固定器治疗小儿下肢骨不连接的临床研究

目的：运用Ilizarov技术辅以手术治疗小儿胫（股）骨不连接。方法：本组共9例，做骨不连处纵切口，切除骨不连处瘢痕，纤维瘤样组织，硬化骨，部分增厚的骨膜，骨不连处植骨，克氏针固定维持胫（股）骨轴线及对合，Ilizarov外固定器固定患肢。结果： 经0．6－5年随访，7例病人骨不连愈合，已拆除外固定器。结论：治疗骨不连接时，切除病变十分重要，胫（股）骨近端骨延长术无助于远端骨不连接的愈合，早日手术有助于骨不连愈合。     

单侧手术修复腭裂的初步报告

目的为减少对面型主体结构的损伤，延长患侧腭，采用单侧手术修复腭裂。材料与方法手术方法系只用患侧腭粘骨膜瓣修复裂隙，并做腭骨水平板切骨后移延长。本组手术26例，男性18例，女性8例；手术时年龄为6个月～8岁，平均22.5个月；裂隙宽度最大18mm，最小8mm，平均为12mm。结果手术患儿全部正常痊愈出院。无喉水肿、呼吸道感染、继发性出血、伤口裂开或穿孔等并发症。结论单侧手术可成功用于腭裂初期修复；减少对面型主体结构的损伤和瘢痕；使患侧短小的腭适当延长，与健侧协调一致。     

伊利扎诺夫外固定架矫治肢体短缩并骨不连

目的：观察伊利扎诺夫外固定架一期完成肢体延长和骨不加压融合手术的疗效。方法：（1）切除骨不连区域瘢痕和硬化骨，用伊氏外固定架牵开骨不连区延长肢体，于牵开区内植入自体骨，再利用外固定架加压融合。（2）清除骨不连区瘢痕后，用3组外固定架在对骨不连区加压的同时，于骨干的上端或下端进行截骨延长，结果：患者骨融合和肢体延长获得成功，结论：伊利扎诺夫技术用于矫治肢骨不连短缩疗效可靠，针道感染是其主要并发症。     

单向循环拉伸应变作用下成骨细胞动力学响应的实验研究

目的 研究Wistar大鼠成骨细胞在不同基底应变作用下，细胞相对增殖指数与加载时间的关系。方法 采用自行研制的细胞单向循环等应变加载装置对成骨细胞加载。实验分为500，1000，1500με3组，用流式细胞仪进行细胞DNA分析。结果 在3种不同应变水平下，成骨细胞在加载12h时相对增殖指数最大，随着加载时间的增加而逐渐趋向于1。结论 成骨细胞是一种对力学因素可兴奋的细胞，单向循环拉伸应变在生理范围内可以促进成骨细胞的增殖与分化。     

胫骨远端延长术疗效8年随访报告

目的：观察、探讨胫骨远端延长术的远期疗效及并发症。方法：胫骨远端骨骺牵伸延长术、胫骨下端截骨延长术。结果：共３９例下肢不等长患，经８年随访，优：２８例；良：１１例，差：０例。结论：胫骨远端延长术是治疗下枝不等长的理论术式，具有创伤小，愈合快，并发症少等优点，远期疗效满意。     

成人一侧股骨、胫骨分段延长术

 目的设计股骨胫骨分段延长术治疗严重短肢合并股骨前倾角畸形疑难病例.方法1990年5月～1999年12月用该术式实施的脊髓灰质炎后遗成人严重短肢合并股骨上端畸形12例.结果随访时间最短2 a,最长9 a,平均6 a.12例中胫骨延长从3.5～5.5cm,平均4.4 cm;股骨延长1.6～3.5 cm,平均2.7 cm,股骨胫骨共延长5.1～8.5 cm,平均7.1 cm;前倾角畸形明显改善.结论股骨胫骨分段延长术是治疗严重短肢合并股骨上端畸形的一种有效治疗方法.