【Abstract】 Objective To review the basic and clinical research progress of lateral column lengthening (LCL).Methods The recent literature concerning LCL at home and abroad was extensively reviewed, and the research and development were summarized. Results LCL is one of the important surgical procedures for flatfoot deformity, and it has two procedures. There are some disputes in surgical selection of the Evans osteotomy and calcaneocuboid distraction arthrodesis for the treatment of flatfoot deformity. Conclusion Lateral column lengthening has been used more widely in clinical practice, but biomechanical and the long-term follow-up are needed.
Objective To review the methods of metacarpal and phalange lengthening and to point out the problems at present as well as to predict the trend of development in the field. Methods Domestic and abroad l iterature concerning the methods of metacarpal and phalange lengthening in recent years was reviewed extensively and thoroughly analyzed. Results At present, there are many methods to treat the short finger disabil ity, but the methods of metacarpal and phalange lengthening have an advantage, which include closed osteotomy lengthening, callus-lengthening, and modified Il izarovmethod. Each surgical method has its advantages and l imitations. However, the part of osteotomy, the length and speed, and the postoperative compl ications etc. have been disputed. Conclusion The modified Il izarov method has the advantages of simple operation, minimal invasion, and less compl ications, but the long-term results of each treatment method are unknown and need more further studies.
Objective To investigate the feature and regularity of the collagen change in bone healing during bone lengthening. Methods Bone lengthening model was made in the middle segment of the rabbit tibia. Five days after the model was established, the bone was lengthened 1.5 mm perday for 14 days. The rabbits were put to death after elongation, 7,14,21,30,40,50,60 and 70 days after elongation. The distracted area of the bone was imbedded with paraffin. After being stained by the picric acidsirius red staining, the slice was observed under polarized microscope. Results The features of the collagen change in the distracted bone were as follows: ① In the fibrous tissue of the distracted area during lengthening period and the early stage after lengthening, there was not only collagen Ⅲ but alsomuch collagen Ⅰ. ② Collagen Ⅰ, Ⅱ and Ⅲ were observed in the cartilage. ③ Collagen Ⅰ, Ⅱ and Ⅲ were also observed in the pseudogrowth plate. ④ Collagen Ⅰ took the dominance during lengtheningperiod and the late stage after lengthening. Conclusion New bone formation in bone lengthening is under the distracted force, so the collagen changes have different features compared with that in fracture healing. Collagen Ⅰ, Ⅱ and Ⅲcan be identified by picric-acid-sirius red staining and polarized microscope, so a new method for studying the collagen typing in bone repairing is provided.
Objective To investigate the relationship between the tibia callus diameter ratio(CDR) and prognosis during tibial distraction and the occurrenceof late deformity or fracture. Methods We measured tibiallengthening callus diameter and added up the cases of angular deformity and fracture in 68 casesfrom January 1996 to December 2001, to calculated callus diameter ratios and compare the relationship between the tibia callus diameter during tibial distraction and the occurrence of late callus angular deformity or fracture. Results In 23 cases of CDRlt;80%, 13 cases had new bone fracture, 21 cases had angular deformity gt;5 degree. In 6 cases of 81%lt;CDRlt;85%, there were 4 cases of angular deformity gt;5 degree. In the other 39 cases of CDRgt;85%, there were no fracture and angular deformity. Conclusion When the CDR was gt;85%, there wereno angular deformity and fracture, but when the CDR was lt;80%, the complications of fracture and angular deformity occur. CDR is a better alarming index for preventing the complications occurring in tibial lengthening.
OBJECTIVE: To study the therapy effect of improved bilateral tibia lengthening. METHODS: From May 1997 to May 2000, 32 patients (varus knee deformity in 8 cases) with low stature were adopted in this study. Among them, there were 26 females and 6 males, aged from 18 to 45 years old. Operative procedures included: 1. tibia osteotomy 1 cm distal from tibia tuberosity and fibula osteotomy 10 cm proximal from lateral malleolus; 2. fixation of the tibia osteotomy with interlocking nail and locking the proximal nail; 3. fixation of the lengthening apparatus; 4. lengthened bilateral tibia 0.7 mm per day; 5. removed the apparatus and locked the distal nail 2 weeks later after limb lengthening was over. RESULTS: The mean distance of lengthening was 8.5 cm (ranged 3.5 to 12.0 cm), the mean duration of lengthening was 128 days(ranged 53 to 180 days), and the mean time of bone union was 180 days (ranged 120 to 270 days). Followed up for 1 to 3 years, 98% patients felt satisfactory in lengthening, gait and joint movement. CONCLUSION: The improved bilateral tibia lengthening technique is recommended for advantage of short time of bone union, less complication and correcting the varus deformity of knee simultaneously.
In order to study the effect of Chinese traditional medicine, "Bone Growth Fluid", on bone formation in bone lengthening, the limb lengthening model was made on goat to observe bone formation in the distracted area, and the content of the trace elements was determined. The bone-lengthening operation was carried out on the upper metaphysis of left tibia. The animals were divided into two groups following operation. From 2nd day afteroperation, "Bone Growth Fluid", 10 ml per kilogram body weight, was given daily to goats in the experimental group, and same amount of normal saline was given to goats in another group as control. The results showed-that new bone formation and bone remodeling in the experimental group appeared earlier than that in the control group, and the content of the trace elements was also improved. So Chinese Traditional medicine, "Bone Growth Fluid", could accelerate the accumulation of the trace elements in callus on the distracted sites and it might play some role in the promotion of osteogenesis and bone remodeling in bone lengthening.
ObjectiveTo analyze the clinical efficacy of Ilizarov bone transport and bone lengthening in the treatment of long bone infection and limb shortening, and fracture nonunion caused by infection. MethodsWe retrospectively analyzed the clinical data of 13 patients with long bone infection, chronic osteomyelitis of the femur and tibia, and infectious bone nonunion, treated with infection focus removal, Ilizarov outer fixation, bone transport and bone lengthening between June 2011 and October 2013. Among the patients, 8 of them had chronic osteomyelitis of the femur and tibia, 4 had infectious bone nonunion, and one had chronic fibula osteomyelitis. ResultsAll the 13 patients had a first-stage healing of the sinus tract and junctions. Among the patients who did the bone transport by themselves after being discharged from hospital, two had nail infections (one was cured after debridement, and the other underwent amputation after re-infection after debridement). One had a re-fracture after the healing of the previous fracture, and was cured by intramedullary nailing. The length of bone transport in these 13 cases ranged from 5 to 13 cm, averaging 7.5 cm. After bone transport, 11 patients had equal length of the lower limbs, and the affected lower limb of the other two patients became shorter than before. No neural function damage occurred in all the patients. ConclusionIlizarov bone transport and lengthening technique is an effective way to treat infections and bone defect of long bone, and it can improve patients' quality of life greatly.
ObjectiveTo explore the effectiveness of bone transportation by ring type extenal fixator combined with locked intramedullary nail for tibial non-infectious defect. MethodsBetween 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). ResultsAll 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%. ConclusionBone 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.
ObjectiveTo provide the anatomical basis for the selection of osteotomy site in leg lengthening or tibial slip. MethodsBetween August 2010 and July 2014, 10 adult fresh amputated leg specimens were collected. The pressure perfusion of red latex was performed by the popliteal artery. The anterior tibial artery and its main branches were separated and exposed, and the periosteal branch of anterior tibial artery was adequately exposed;the posterior tibial artery and its main branches were exposed;the peroneal artery was separated and exposed. The tibial and peroneal artery and its branches were observed and measured. When measuring the proximal end, the medial tibial plateau bone margin, the most prominent part of the tibial tuberosity, and the fibular head edge were used as a reference;when measuring the distal end, distal medial condyle of tibia malleolus tip, tibial lateral malleolus lateral tip, and distal tibial articular surface were used as a reference;the vertical distance between tibia proximal and distal main arteries and bone end reference was measured to determine the optimal osteotomy position of upper and lower tibia. The osteotomy index was calculated which was used to represent the relative position of osteotomy site in the whole tibia. ResultsThe proximal tibial osteotomy site located at (78.2±19.5) mm from medial tibial plateau margin, (41.8±16.0) mm from the tibial tuberosity pole, and (66.7±16.4) mm from the fibular head edge. The distal tibial osteotomy site located at (70.8±12.1) mm above the inferior margin of tibial medial malleolus, (83.3±13.0) mm above the inferior margin of lateral malleolus tip, and (59.1±11.7) mm from distal tibial articular surface. The proximal tibial osteotomy index was 18.45-23.35 (mean, 20.46);the distal tibial osteotomy index was 14.36-23.05 (mean, 18.81). ConclusionThe metaphyseal-diaphyseal connection shold be selected in the proximal and distal tibia osteotomy, the lower one third of the tibia is not suitable for ostetomy.