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. 2017 Aug 15;31(8):941-945.
doi: 10.7507/1002-1892.201704015.

[Effectiveness of limbs shortening and re-lengthening in treatment of tibial infectious bone defect and chronic osteomyelitis]

[Article in Chinese]
Zhimin Guo  1 , Lingling Shi  2 , Sheng Tian  2 , Wei Chen  2 , Bin Lin  2
Affiliations

[Effectiveness of limbs shortening and re-lengthening in treatment of tibial infectious bone defect and chronic osteomyelitis]

[Article in Chinese]
Zhimin Guo et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. .

Abstract
in English, Chinese

Objective: To evaluate the limbs shortening and re-lengthening in the treatment of tibial infectious bone defect and chronic osteomyelitis.

Methods: Between January 2011 and April 2016, 19 cases of tibial infectious bone defect and chronic osteomyelitis were treated with the limbs shortening and re-lengthening technique. There were 13 males and 6 females, aged from 22 to 62 years (mean, 44 years). The causes of injury included traffic accident injury in 16 cases, crush injury in 1 case, and falling from height in 2 cases. One patient was infected after plate internal fixation of closed tibial fracture and 18 patients after external fixation of open tibial fractures (Gustilo type IIIB). The mean previous operation times was 3 times (range, 2-5 times). The time from injury to bone transport operation was 3-11 months (mean, 6.5 months). The bone defect length was 2.0-5.5 cm (mean, 4.3 cm) after debridement. After tibial shortening, limb peripheral blood supply should be checked after release of the tourniquet. Seven wounds were closed directly, 5 were repaired with adjacent skin flap, 5 were repaired with sural neurovascular flap, 1 was repaired with medial head of gastrocnemius muscle flap, and 1 underwent skin grafting. Single arm external fixator or ring type external fixator were used, and completely sawed off between 2 sets of external fixation screws at proximal and distal metaphysis of the tibia. Limb lengthening was performed after 1 week with the speed of 1 mm/d.

Results: All patients were followed up 10-36 months with an average of 14 months. Two cases delayed healing of the wound after operation, and the other wounds healed primarily. Natural healing of the opposite end of the bone were found in 18 cases, and 1 case had nonunion in the opposite end of the bone because of incomplete removal of lesion bone. There were 5 cases of slow growth of the callus, and healed smoothly by "accordion" technology and injecting red bone marrow in 4 cases, and by bone grafting and internal fixation in 1 case. The time of bone lengthening was 1-3 months, the prolongation index was 1.6-2.7 cm/month (2.20 cm/month). The bone healing time was 7-13 months (mean, 11.1 months). According to tibial stem diagnostic criteria Johner-Wruhs score, 9 cases were excellent, 8 cases were good, 2 cases were fair, with an excellent and good rate of 89.5%.

Conclusion: Limbs shortening and re-lengthening is an effective method for the treatment of tibial infectious bone defect and chronic osteomyelitis, with the advantages of improving the immediate alignment of the osteotomy ends, significantly shortening the bone healing time of opposite ends of bone.

目的: 探讨采用肢体短缩延长术治疗胫骨感染性骨缺损及慢性骨髓炎的疗效。.

方法: 2011 年 1 月—2016 年 4 月采用肢体短缩延长术治疗胫骨感染性骨缺损及慢性骨髓炎 19 例。男 13 例，女 6 例；年龄 22～62 岁，平均 44 岁。致伤原因：交通事故伤 16 例，压砸伤 1 例，高处坠落伤 2 例。18 例为小腿开放性骨折（Gustilo ⅢB 型）外固定支架固定后形成感染性骨缺损、骨髓炎，1 例为闭合骨折内固定术后感染形成慢性骨髓炎。既往手术 2～5 次，平均 3 次。受伤至骨搬移术时间为 3～11 个月，平均 6.5 个月。清创后骨缺损长度为 2.0～5.5 cm，平均 4.3 cm。术中胫骨短缩后松开止血带检查肢体末梢血运，7 例直接闭合创面，5 例采用邻近皮瓣修复，5 例采用腓肠神经营养血管皮瓣修复，1 例采用腓肠肌内侧头肌皮瓣修复，1 例单纯植皮修复。选用单臂外固定架或环式外固定架，并在胫骨近侧或远侧干骺端的两排外固定架钉之间完全锯断；1 周后以 1 mm/d 速度进行肢体延长。.

结果: 术后 19 例患者均获随访，随访时间 10～36 个月，平均 14 个月。2 例对合端创面延迟愈合，余均顺利愈合。18 例对合骨端自然愈合，1 例因病灶骨未完全切除致对合骨端发生骨不连。5 例发生牵张骨痂生长缓慢，其中 4 例经“手风琴”技术和注射红骨髓后顺利愈合，1 例植骨辅助内固定后对合骨端愈合。骨延长时间为 1～3 个月，延长指数为 1.6～2.7 cm/月，平均 2.2 cm/月；骨愈合时间为 7～13 个月，平均 11.1 个月。根据胫骨骨折疗效评定系统 Johner-Wruhs 评分评定疗效：优 9 例，良 8 例，中 2 例，优良率为 89.5%。.

结论: 采用肢体短缩延长术治疗胫骨感染性骨缺损及慢性骨髓炎，可改善截骨端的直接对合，明显缩短骨对合端的愈合时间。.

Keywords: Tibial infectious bone defect; bone transport; chronic osteomyelitis.

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A typical case 典型病例
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