2015年 · 第53卷第06期

The treatment of large segment bone defects of lower limbs is a common and difficult problem in clinical practice. It is difficult to solve the problems of insufficient bone mass and difficult healing of implanted bone by simply using cancellous bone grafting^[1,2]。 The current gold standard for the treatment of this type of disease is vascularized fibular bone grafting and bone transport. However, the former has higher requirements for surgical technique, and there is a risk of donor site injury, stress fracture and nonunion^[3,4]Once the operation fails, it is difficult for the patient to accept; The latter requires patients to wear external fixators for a long time, causing inconvenience in life and inevitable complications such as needle tract infection. Some scholars use bone transport combined with internal fixation to treat large segment bone defects, and believe that it has the advantages of reliable fixation, retaining force line, effective maintenance of limb length and early removal of external frame. We treated a case of femoral bone defect by retaining the original bone plate and unilaterally reconstructing the external frame for bone transport. The satisfactory results are reported below.

A 40-year-old male was injured by a collapsed wall on June 5, 2012. At that time, he was diagnosed as: left ankle joint fracture (type B2), right femoral shaft fracture (type A3), right acetabular fracture (transverse with posterior wall), pelvic fracture (types B1~3), and intestinal rupture. The injury severity score (ISS) was 34. The patient underwent emergency intestinal rupture repair on June 6, 2012, femoral shaft open reduction and plate internal fixation on June 12, left ankle joint open reduction and internal fixation on June 25, 2012, and pelvic and acetabular fractures all the way to tibial tuberous bone traction. For further treatment of pelvic and acetabular fractures, he was transferred to our hospital on July 5th. Physical examination after admission: bed rest, good mental state, good healing of surgical incisions in abdomen and right femur, mild redness and swelling of surgical incisions in left ankle joint, no abnormalities in diet, urine and stool; Laboratory test: White blood cell count: 6.71×10⁹/L, erythrocyte sedimentation rate: 45 mm/1 h, CRP: 11.80 mg/L, blood glucose: 12.0 mmol/L. X-ray and CT examination at admission showed: after fixation of right femoral shaft and left lateral malleolus plate, right sacroiliac joint separation, right acetabular fracture with central dislocation of femoral head, left pubesciatic branch fracture, sacroiliac joint separation and acetabular fracture site with large amount of callus formation (Figure 1，Figure 2)。