Lei Ting,Zhu Guanghui,Mei Haibo,et al.Efficacy of one-stage bone transport and two-stage wrapped bone grafting in the treatment of large bone defect after congenital tibial pseudoarthroplasty in children[J].Journal of Clinical Pediatric Surgery,,21():336-340.[doi:10.3760/cma.j.cn101785-202110044-008]
Efficacy of one-stage bone transport and two-stage wrapped bone grafting in the treatment of large bone defect after congenital tibial pseudoarthroplasty in children
- Keywords:
- Congenital Pseudoarthrosis of Tibia; Orthopedic Procedures/MT; Large Bone Defect; Bone Transportation; Wrapped Bone Graft
- Abstract:
- ObjectiveTo evaluate the clinical effects of one-stage bone transport and two-stagewrapped bone grafting in the treatment of large bone defect after congenital tibial pseudoarthroplasty in children.MethodsA retrospective analysis was performed on the cases of large bone defect after pseudoarthroplasty in children,who was treated with one-stage bone transport and two-stagewrapped bone grafting.One-stage tibial bone transport was performed in all cases with follow-up at every 2 weeks,the rate of lengthening of the tibia was 0.5 mm/day,and the transport speed was adjusted according to the quality of the callus.During the lengthening process,function exercises were strengthened for knee and ankle joint,and tibial lengthening fixator was used to prevent contractures.After the fracture ends of tibial pseudoarthrosis ends were aligned,the two-stage stage surgery of tibial pseudoarthrosis excision and wrapped bone grafting was performed.The external fixator was removed after initial healing of tibial pseudoarthrosis and transported segment.The length and healing time of bone transport,healing index,external fixation time and complications were recorded.SPSS20.0 was used to analyze the data.ResultsA total of 6 patients with an average age of(7.5±3.1)years were enrolled in this study,including 4 males and 2 females.All patients were followed up satisfactorily with an average of 62 months.The total bone transport length was(6.7±2.8)cm,and the bone transport time was(138.7±58.1)days.The bone healing time was(328.7±103.4)days and the bone transport healing index was(46.7±12.8)d/cm.The duration of external fixator use was(275.0±74.3)days.3 cases(50%)had pin tract infection and were cured by oral Cefixime.The end of the intramedullary rod was detached from the plantar of the foot in 1 case(16.7%), which was solved by pushing the intramedullary rod upward to the proximal tibia by surgery.In one case(16.7%),the transported segment of tibia was healed in advance.Angulation of osteotomy segment was found in 1 case(16.7%),which was treated by adjusting external fixator.None of vascular nerve injury or osteomyelitis was observed.At the end-point follow-up,4 cm shortening of tibia was occurred in 1 patient and less than 1 cm in other cases.During the follow up,neither further fracture of the elongated segment nor the tibial pseudo-articular segment was observed.ConclusionIn children with large bone defects after congenital tibial pseudarthrosis surgery,one-stage bone transport and two-stage wrapped bone grafting is a preferable method with a high healing rate despite the high healing index and the long external fixation time.
References:
[1] Shannon CE,Huser AJ,Paley D.Cross-union surgery for congenital pseudarthrosis of the tibia[J].Children (Basel),2021,8(7):547.DOI:10.3390/children8070547.
[2] Zhu GH,Mei HB,He RG,et al.Combination of intramedullary rod,wrapping bone grafting and Ilizarov’s fixator for the treatment of Crawford type IV congenital pseudarthrosis of the tibia:mid-term follow up of 56 cases[J].BMC Musculoskeletal Disorders,2016,17(1):443.DOI:10.1186/s12891-016-1295-1.
[3] El-Gammal TA,El-Sayed A,Kotb MM,et al.Crawford type iv congenital pseudarthrosis of the tibia:treatment with vascularized fibular grafting and outcome at skeletal maturity[J].J Pediatr Orthop,2021,41(3):164-170.DOI:10.1097/BPO.0000000000001751.
[4] Wen H,Zhu S,Li C,et al.Bone transport versus acute shortening for the management of infected tibial bone defects:a meta-analysis[J].BMC Musculoskelet Disord,2020,21(1):80.DOI:10.1186/s12891-020-3114-y.
[5] Meselhy MA,Elhammady AS,Singer MS.Outcome of induced membrane technique in treatment of failed previously operated congenital pseudarthrosis of the tibia[J].Orthop Traumatol Surg Res,2020,106(5):813-818.DOI:10.1016/j.otsr.2019.11.033.
[6] 梅海波,赫荣国,刘昆,等.包裹式自体髂骨移植治疗儿童先天性胫骨假关节的疗效观察[J].临床小儿外科杂志,2011,10(3):163-166.DOI:10.3969/j.issn.1671-6353.2011.03.002. Mei HB,He RG,Liu K,et al.Observation on the effect of wrapped autologous iliac bone transplantation in the treatment of congenital pseudarthrosis of tibia in children[J].J Clin Ped Sur,2011,10(3):163-166.DOI:10.3969/j.issn.1671-6353.2011.03.002.
[7] Paley D.Congenital pseudarthrosis of the tibia:biological and biomechanical considerations to achieve union and prevent refracture[J].J Child Orthop,2019,13(2):1-14.DOI:10.1302/1863-2548.13.180147.
[8] Eisenberg KA,Vuillermin CB.Management of congenital pseudoarthrosis of the tibia and fibula[J].Curr Rev Musculoskelet Med,2019,12(3):356-368.DOI:10.1007/s12178-019-09566-2.
[9] Abdelkhalek M,El-Alfy B,Ali AM.Ilizarov bone transport versus fibular graft for reconstruction of tibial bone defects in children[J].J Pediatr Orthop B,2016,25(6):556-560.DOI:10.1097/BPB.0000000000000334.
[10] 梅海波,汤用波,刘昆,等.Masquelet技术治疗儿童先天性胫骨假关节[J].中华小儿外科杂志,2015,36(5):331-334.DOI:10.3760/cma.j.issn.0253-3006.2015.05.004. Mei HB,Tang YB,Liu K,et al.Masquelet technique in the treatment of congenital pseudarthrosis of tibia in children[J].Chin J Pediatr Surg,2015,36(5):331-334.DOI:10.3760/cma.j.issn.0253-3006.2015.05.004.
[11] Cho TJ,Choi IH,Lee KS,et al.Proximal tibial lengthening by distraction osteogenesis in congenital pseudarthrosis of the tibia[J].J Pediatr Orthop,2007,27(8):915-920.DOI:10.1097/bpo.0b013e31815a6058.
[12] Zhu GH,Mei HB,,He RG,et al.Effect of distraction osteogenesis in patient with tibial shortening after initial union of Congenital Pseudarthrosis of the Tibia (CPT):a preliminary study[J].BMC Musculoskeletal Disorders,2015,16(1):1-6.DOI:10.1186/s12891-015-0680-5.
[13] Sen C,Eralp L,Gunes T,et al.An alternative method for the treatment of nonunion of the tibia with bone loss[J].J Bone Joint Surg Br,2006,88(6):783-789.DOI:10.1302/0301-620X.88B6.17515.
[14] Rozburch SR,Ilizarov S.Limb lengthening and reconstruction surgery[M].New York:Informa Healthcare,2007:27-31.
[15] Atbasi Z,Demiralp B,Kilic E,et al.Angiographic evaluation of arterial configuration after acute tibial shortening[J].Eur J Orthop Surg Traumatol,2014,24(8):1587-1595.DOI:10.1007/s00590-013-1327-6.
Memo
收稿日期:2021-10-30;改回日期:。
基金项目:湖南省发展和改革委员会创新研发项目(湘发改投资[2019]875号);湖南省临床医疗技术创新项目(2020SK50518);湖南省重点研发计划(2020SK2113)
通讯作者:赵卫华,Email:zhaoweihua100@163.com