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Title: [Application of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors].
Author: Ji T, Guo W, Yang R, Tang X, Li D, Yang Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Oct 15; 31(10):1161-1167. PubMed ID: 29806314.
Abstract:
OBJECTIVE: To investigate the surgical characteristics and preliminary effectiveness of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors. METHODS: Twenty-two patients received Orthofix unilateral external fixator treatment for bone defect after tumor excision or complications after limb salvage surgery between June 2011 and March 2016. There were 11 males and 11 females with a median age of 23.5 years (range, 4-57 years). The bone defect or limb length discrepancy after tumor resection was at proximal femur in 6 cases, distal femur in 8 cases, diaphysis of femur in 3 cases, proximal tibia in 2 cases, and diaphysis of tibia in 3 cases. The external fixation was used for temporary fixation after reconstruction of bone defect in 10 cases [the length of bone defect was 6-19 cm (mean, 12.3 cm); using vascularized fibular graft in 2 cases, allograft bone and free fibular graft in 2 cases, allograft bone and autogenous bone graft in 5 cases, allograft bone reconstruction in 1 case]; bone distraction lengthening for limb length discrepancy in 5 cases [the length of shortening was 6.5-8.5 cm (mean, 7.5 cm)]; temporary fixation after open biopsy in 3 cases; bone transportation over locking plate in 1 case (the length of bone defect was 7.5 cm); fixation for preoperatively pathology fracture in 1 case; and joint distraction for dislocation after tumor ablation in 2 cases. RESULTS: All the patients were followed up 12-72 months (mean, 36 months). In 10 patients with bone defect reconstruction, the wearing external fixator time was 3-8 months (mean, 4.8 months); all got bone union with the healing time of 3-16 months (mean, 6.4 months); the Musculoskeletal Tumor Society 93 (MSTS 93) score was 73.3-93.3 (mean, 87.2); and no complication occurred during wearing external fixator. In 5 patients with bone distraction lengthening for limb length discrepancy, the wearing external fixator time was 7-15 months; 2 patients had axial deviation during distraction and2 had greenstick fracture after apparatus removal; pin site infection was observed in 2 cases with grade 1 and 1 case with grade 2 according to Checketts-Otterburn classification system; the MSTS 93 score was 80.0-96.7 (mean, 89.2). The remaining patients had no complications, the knee and ankle joint movement was normal. CONCLUSION: Orthofix unilateral external fixator can be used in fixation for complex bone defect after tumor resection and to correct limb length discrepancy after limb salvage surgery. 目的: 探讨 Orthofix 单边外固定架在骨肿瘤外科治疗中的应用特点及初步临床效果。. 方法: 回顾分析 2011 年 6 月—2016 年 3 月因原发良、恶性骨肿瘤接受外科治疗并应用 Orthofix 单边外固定架的 22 例患者临床资料。男 11 例，女 11 例；年龄 4～57 岁，中位年龄 23.5 岁。肿瘤切除后骨缺损或肢体短缩部位：股骨上段 6 例，股骨下段 8 例，股骨中段 3 例，胫骨上段 2 例，胫骨中段 3 例。外固定架应用情况：骨缺损重建后临时固定 10 例（骨缺损长度 6～19 cm，平均 12.3 cm；采用带血管蒂腓骨移植 2 例，同种异体骨+游离腓骨移植 2 例，同种异体骨+自体骨移植 5 例，同种异体骨重建 1 例）；肢体短缩行骨延长 5 例（短缩长度 6.5～8.5 cm，平均 7.5 cm）；3 例术前活检无法明确诊断，行切开活检，为预防病理骨折临时采用外固定架固定；肿瘤切除后骨缺损应用骨搬运 1 例（骨缺损长度 7.5 cm）；病理骨折术前化疗临时固定 1 例；股骨远端骨肉瘤行海扶刀治疗后，膝关节严重屈曲畸形伴关节脱位矫形 2 例。. 结果: 22 例患者均获随访，随访时间 12～72 个月，平均 36 个月。10 例骨缺损重建患者带架时间 3～8 个月，平均 4.8 个月；均获满意骨愈合，愈合时间 3～16 个月，平均 6.4 个月；末次随访时国际保肢学会功能评分 93 版（MSTS 93）评分为 73.3～93.3 分，平均 87.2 分；患者佩戴外固定架期间未出现并发症。5 例骨延长患者带架时间 7～15 个月；2 例延长过程中出现成角畸形，2 例拆架后出现青枝骨折，Checketts-Otterburn 外固定架钉道感染分级为轻度感染 1 级 2 例，2 级 1 例；MSTS 93 评分为 80.0～96.7 分，平均 89.2 分。其余患者均无相关并发症发生，膝关节及踝关节活动正常。. 结论: Orthofix 单边外固定架可用于骨肿瘤切除后复杂缺损的固定，并可通过骨延长纠正儿童保肢术后肢体不等长问题。.

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