BONE TRANSPORTATION BY RING TYPE EXTERNAL FIXATOR COMBINED WITH LOCKED INTRAMEDULLARY NAIL FOR TIBIAL NON-INFECTIOUS DEFECT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGBin ¹ , JIASong ¹ , LUAidong ² , QINSihe ³ , LIUWei ¹ , HAORuizheng ¹ , WANGWei ¹ , HUOYongxin ¹ , ZHAOGang ¹

1. The 1st Department of Hand Surgery, Reconstruction Surgery, the Second Hospital of Tangshan(The Orthopedic Hospital Affiliated to North China University of Science and Technology), Tangshan Hebei, 063000, P. R. China;
2. Department of Ophthalmology, Kailuan General Hospital Affiliated to North China University of Science and Technology;
3. Department of Orthopaedics, Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical Aids;

Corresponding author：

WANGBin, Email: wbladyp3@163.com

Keywords：

Tibial bone defect; Intramedullary nail; External fixator; Distraction osteogenesis; Bone lengthening

DOI：

10.7507/1002-1892.20150291

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Objective To explore the effectiveness of bone transportation by ring type extenal fixator combined with locked intramedullary nail for tibial non-infectious defect. Methods Between June 2008 and October 2012, 22 cases of tibial large segment defect were treated. There were 15 males and 7 females, aged 24-58 years (mean, 36.8 years), including 17 cases of postoperative nonunion or malunion healing, and 5 cases of large defect. After debridement, bone defect size was 5.0-12.5 cm (mean, 8.05 cm). Bone transportation was performed by ring type external fixator combined with locked intramedullary nail, the mean indwelling duration of external fixation was 10.2 months (range, 2-26 months); the external fixation index was 1.57 months/cm (range, 0.3-3.2 months/cm); and the mean length increase was 8.05 cm (range, 5.0-12.5 cm). Results All patients were followed up 19-58 months (mean, 32 months). No infection occurred after operation and all patients obtained bony union, and the union time was 4.7-19.4 months (mean, 11.9 months). Complications included refracture (1 case), skin crease (1 case), lengthening failure (1 case), foot drop (2 cases), retractions of the transport segment (1 case), delay of mineralization (1 case), which were cured after corresponding treatment. According to Hohl knee evaluation system to assess knee joint function after removal of external fixator and intramedullary nail, the results were excellent in 15 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 90.9%; according to Baird-Jackson ankle evaluation system to evaluate ankle joint function, the results were excellent in 10 cases, good in 3 cases, fair in 7 cases, and poor in 2 cases, with an excellent and good rate of 59.1%. Conclusion Bone transportation by ring type external fixator combined with locked intramedullary nail could increase stability of extremities, allow early removal of external fixator and avoid axis shift of extremities, so it has good effect in treating tibial noninfectious defect.

Citation： WANGBin, JIASong, LUAidong, QINSihe, LIUWei, HAORuizheng, WANGWei, HUOYongxin, ZHAOGang. BONE TRANSPORTATION BY RING TYPE EXTERNAL FIXATOR COMBINED WITH LOCKED INTRAMEDULLARY NAIL FOR TIBIAL NON-INFECTIOUS DEFECT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1348-1352. doi: 10.7507/1002-1892.20150291 Copy

1.	Hohl M. Fractures of the proximal tibia. Philadelphia:JB Lippincott, 1991:1725-1762.
2.	Baird RA, Jackson ST. Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament. J Bone Joint Surg (Am), 1987, 69(9):1346-1352.
3.	杨益民, 任志伟, 李萌, 等. 胫骨骨折术后骨外露原因分析及对策. 中国骨与关节损伤杂志, 2011, 26(10):948-949.
4.	Birch R. A history of limb amputation. J Bone Joint Surg (Br), 2008, 90(10):1276-1277.
5.	Hostrup H, Pilgaard S. Epiphysiodesis and epiphyseal stapling on the lower limbs. Acta Orthop Scand, 1969, 40(1):130-136.
6.	Birch JG, Walsh SJ, Small JM, et al. Syme amputation for thetreatment of fibular deficiency. An evaluation of long-term physicaland psychological functional status. J Bone Joint Surg (Am), 1999, 81(11):1511-1518.
7.	项毅, 续力民, 孙振军, 等. 骨搬移技术治疗胫骨感染性骨外露. 中国骨与关节损伤杂志, 2014, 29(1):92-93.
8.	黄雷, 朱峰, 王慎东, 等. 外固定器结合髓内钉延长术治疗股骨缺损和不等长. 中华创伤骨科杂志, 2006, 8(7):634-638.
9.	夏和桃, 彭爱民, 罗先正, 等. 带锁髓内钉与骨延长器联合应用在小腿延长中的作用. 中华外科杂志, 2005, 43(8):495-498.
10.	王斌, 王鹏飞, 杨焕友, 等. 外固定器在膝及小腿血管损伤修复中的应用. 中华骨科杂志, 2012, 32(3):229-234.
11.	黄正, 冯伟, 付文彧, 等. 扩髓治疗骨折不愈合中的血管分布研究. 中华创伤骨科杂志, 2008, 10(5):440-445.
12.	De Bastiani G, Aldegheri R, Renzi-Brivio L, et al. Limb lengthening by callus distraction (callotasis). J Pediatr Orthop, 1987, 7(2):129-134.
13.	Wu CC, Chen WJ. Tibial lengthening:technique for speedy lengthening by external fixation and secondary interal fixation. J Trauma, 2003, 54(6):1159-1165.
14.	Baiomy AA, Nassan MA, Abdellatif EM, et al. Experimental comparison of the effects of locally administered zoledronic acid and alendronate on the rate of mandibular distraction osteogenesis in dogs. Oral Surg Oral Med Oral Pathol Oral Radiol, 2014, 118(1):35-42.
15.	Ma D, Ren L, Yao H, et al. Locally injection of cell sheet fragments enhances new bone formation in mandibular distraction osteogenesis:a rabbit model. J Orthop Res, 2013, 31(7):1082-1088.
16.	Gulabi D, Erdem M, Cecen GS, et al. Ilizarov fixator combined with an intramedullary nail for tibial nonunions with bone loss:is it effective? Clin Orthop Relat Res, 2014, 472(12):3892-3901.
17.	裴丽霞. 胫骨血供的临床解剖研究. 现代预防医学, 2008, 35(9):1741-1742, 1744.
18.	韦旭明, 孙振中, 芮永军, 等. 一期缩短二期Ilizarov延长技术治疗小腿GustiloⅢC型高能量损伤. 中国骨与关节损伤杂志, 2013, 28(12):1152-1154.
19.	蓝霞. Ilizarov牵张技术在肢体和骨段延长中的应用研究. 北京:解放军医学院, 2013.

1. Hohl M. Fractures of the proximal tibia. Philadelphia:JB Lippincott, 1991:1725-1762.
2. Baird RA, Jackson ST. Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament. J Bone Joint Surg (Am), 1987, 69(9):1346-1352.
3. 杨益民, 任志伟, 李萌, 等. 胫骨骨折术后骨外露原因分析及对策. 中国骨与关节损伤杂志, 2011, 26(10):948-949.
4. Birch R. A history of limb amputation. J Bone Joint Surg (Br), 2008, 90(10):1276-1277.
5. Hostrup H, Pilgaard S. Epiphysiodesis and epiphyseal stapling on the lower limbs. Acta Orthop Scand, 1969, 40(1):130-136.
6. Birch JG, Walsh SJ, Small JM, et al. Syme amputation for thetreatment of fibular deficiency. An evaluation of long-term physicaland psychological functional status. J Bone Joint Surg (Am), 1999, 81(11):1511-1518.
7. 项毅, 续力民, 孙振军, 等. 骨搬移技术治疗胫骨感染性骨外露. 中国骨与关节损伤杂志, 2014, 29(1):92-93.
8. 黄雷, 朱峰, 王慎东, 等. 外固定器结合髓内钉延长术治疗股骨缺损和不等长. 中华创伤骨科杂志, 2006, 8(7):634-638.
9. 夏和桃, 彭爱民, 罗先正, 等. 带锁髓内钉与骨延长器联合应用在小腿延长中的作用. 中华外科杂志, 2005, 43(8):495-498.
10. 王斌, 王鹏飞, 杨焕友, 等. 外固定器在膝及小腿血管损伤修复中的应用. 中华骨科杂志, 2012, 32(3):229-234.
11. 黄正, 冯伟, 付文彧, 等. 扩髓治疗骨折不愈合中的血管分布研究. 中华创伤骨科杂志, 2008, 10(5):440-445.
12. De Bastiani G, Aldegheri R, Renzi-Brivio L, et al. Limb lengthening by callus distraction (callotasis). J Pediatr Orthop, 1987, 7(2):129-134.
13. Wu CC, Chen WJ. Tibial lengthening:technique for speedy lengthening by external fixation and secondary interal fixation. J Trauma, 2003, 54(6):1159-1165.
14. Baiomy AA, Nassan MA, Abdellatif EM, et al. Experimental comparison of the effects of locally administered zoledronic acid and alendronate on the rate of mandibular distraction osteogenesis in dogs. Oral Surg Oral Med Oral Pathol Oral Radiol, 2014, 118(1):35-42.
15. Ma D, Ren L, Yao H, et al. Locally injection of cell sheet fragments enhances new bone formation in mandibular distraction osteogenesis:a rabbit model. J Orthop Res, 2013, 31(7):1082-1088.
16. Gulabi D, Erdem M, Cecen GS, et al. Ilizarov fixator combined with an intramedullary nail for tibial nonunions with bone loss:is it effective? Clin Orthop Relat Res, 2014, 472(12):3892-3901.
17. 裴丽霞. 胫骨血供的临床解剖研究. 现代预防医学, 2008, 35(9):1741-1742, 1744.
18. 韦旭明, 孙振中, 芮永军, 等. 一期缩短二期Ilizarov延长技术治疗小腿GustiloⅢC型高能量损伤. 中国骨与关节损伤杂志, 2013, 28(12):1152-1154.
19. 蓝霞. Ilizarov牵张技术在肢体和骨段延长中的应用研究. 北京:解放军医学院, 2013.

Chinese Journal of Reparative and Reconstructive Surgery

BONE TRANSPORTATION BY RING TYPE EXTERNAL FIXATOR COMBINED WITH LOCKED INTRAMEDULLARY NAIL FOR TIBIAL NON-INFECTIOUS DEFECT

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