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Abstract
For the evaluation of segmentary bone transport (SBT) technique in the treatment of defect pseudarthroses (DPA) of long bones 9 DPA in the lower extremities from 8 patients, that had been operated between 1992 and 1994 at Sisli Etfal Hospital Department of Orthopaedics and Traumatology-Istanbul, were reviewed. The etiology of DPA was motor vehicle accidents in 5 cases, gunshot injuries in 2 cases and sequaele of osteomyelitis in 2 cases. DPA was found at tibia in 8 patients and at femur in only 1 patient. The average age of the patients was 26 years (7-51). All but one patients were male and they all had had some surgical procedures (internal or external osteosynthesis, bone grafting, debridement, Septopal¨-PMMA beads application, skin grafting, fasciocutaneous grafting etc.) before SBT. The average time between injury and SBT procedure was 20 months (1.5-87), average bone loss was calculated as 7.7cm (3-16). 6 of 9 patients were infected at the time of SBT procedure. Circular external fixator (CEF) was applied in 7 and dynamic axial fixator (DAF) in only 2 patients. After corticotomy segment sliding procedure had started on the 11th day (7-17) averagely and distraction rate was 2x0.5 mm/day. Average hospitalization time was 63 days (20-135). The patients remained in fixator for an average of 12.4 months (6-20). The time in fixation averaged 54 days per cm of bone loss (healing index). Average follow up was 24.7 months (10-38). 8 of 9 patients had achieved union. According to Paley s bone criteria 5 were rated as excellent, 2 as good, 1 as fair, 1 as poor and functionally 3 as excellent, 4 as good, 1 as fair and 1 as poor. 6 patients had secondary operations, where 4 of them had autogenous spongiosaplasty at the docking site. As complications 4 superficial pin tract infections, 3 ankle joint stiffness, 1 drop foot due to temporary peroneal nerve lesion and 1 fracture at the site of distraction osteogenesis were encountered. One patient fall down after fixator removal and fractured her tibia at the old pseudarthroses site, but it was unioned with conservative therapy. It s concluded, that the SBT technique is a good alternative to widely used conventional techniques in treatment of the DPA of long bones.
Özet
Uzun kemiklerin defekt psödoartrozlarının (DPA) tedavisnde segmenter kemik transportu (SKT) tekniğinin uygulandığı 8 hastanın 9 alt ekstremite DFA incelendi. OPA nun 8 i tibia, 1’i femura lokalize idi. Vakaların yaş ortalaması (ort.) 26 yıl (7-51), 7 si erkek, 1 i kadın idi. İlk yaralanma SKT arasında geçen süre ort. 20 ay (1, 5-87), kemik kaybı miktarı ort. 7,7 cm (3-16) olarak hesaplandı. SKT uygulandığında 9 vakanın 6 sı infekte idi. 7 vakada sirküler eksternal fiksatör, 2 vakada ise dinamik aksiyel fiksatör kullanıldı. İyileşme indeksi (healing index) ort. 54 gün/cm olarak hesaplandı. Vakalar postop ort. 24,7 ay (10-38) takip edildiler. 9 vakanın 8 inde kaynama elde edildi. Toplam 6 sekonder girişimden 4 ünü segment - ana fragman karşılaşma yerine yapılan otojen spongiozaplasti ameliyatları oluşturdu. Komplikasyon olarak en sık yüzeyel tel dibi infeksiyonu görülürken, 1 vakada distraksiyon osteogenezi bölgesinde kırık gelişti. Tedavi sonrası bir vakada eski psödoartroz bölgesinde düşme sonucu oluşan kırık konservatif tedavi ile kaynadı. Bu çalışmada uzun kemiklerin DPA nun tedavisinde SKT tekniğinin bugüne kadar uygulanan konvansiyonel yöntemlere iyi bir alternatif oluşturduğu sonucuna varıldı.