Application of shortened replantation combined with limb lengthening in treatment of severe amputation of middle and distal lower leg_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 XIE Shuqiang , HOU Jianxi , DONG Qiqiang , ZHANG Huafeng , WANG Hongxin , YANG Chaofan

Department of Trauma Orthopedics, Zhengzhou Renji Hospital, Zhengzhou Henan, 450000, P.R.China;

Corresponding?author：

XIE Shuqiang, Email: xishqi24@163.com

Keywords：

Limb replantation; shortening deformity; limb lengthening

DOI：

10.7507/1002-1892.201703069

Video：

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Objective To investigate the effectiveness and technical points of shortened replantation combined with limb lengthening in the treatment of severe amputation of middle and distal lower leg. Methods Twelve cases of severe amputation of middle and distal lower leg were treated with shortened replantation at the 1st stage and limb lengthening at the 2nd stage between April 2009 and May 2016. There were 9 males and 3 females with an average age of 28 years (range, 16-32 years). The injury causes included traffic accident injury in 4 cases, heavy pound injury in 6 cases, and machine crush injury in 2 cases. The interval from injuries to treatment ranged from 30 minuts to 6 hours (mean, 3 hours and 12 minutes). All of 12 cases, 6 cases were completely amputated in the right middle and distal lower leg, 4 were not completely amputated in the left middle and distal lower leg, and 2 were ankle amputations. The limbs were 4.0-12.5 cm shorter than the contralateral sides, with an average of 7.3 cm. Limb lengthening was performed at 1.5-8.0 months after replantation and the time of extension was 1.7-5.3 months (mean, 3.1 months). Results All 12 patients recovered the same lengths of both lower extremities after shortened replantation and limb lengthening. The lengthened segments gained good bone mineralization, bony union was achieved at lengthened segments and broken end of fracture at 7-16 months (mean, 11.3 months). All patients were followed up 6 months to 5 years (mean, 2 years and 5 months). The range of motion of the knee joint were 0-5° (mean, 3°) in hyperextension and 110-140° (mean, 120°) in flexion. Except for 2 cases of ankle arthrodesis, plantar flexion angles were 15-45° (mean, 26°) and dorsiflexion angles were 10-25° (mean, 15°) in the other cases. The plantar sensation was restored to the S_3⁺ level in 4 cases, S₃ level in 6 cases, and S₂ level in 2 cases. At last follow-up, the affected limb function were excellent in 7 cases, good in 3 cases, fair in 2 cases according to Kofoed functional evaluation criteria. Conclusion It expanded indications for replantation of lower limb amputation, reduced the operation difficulty and trauma with shortened replantation combined with limb lengthening in the treatment of severe amputation of middle and distal lower leg.

Citation： XIE Shuqiang, HOU Jianxi, DONG Qiqiang, ZHANG Huafeng, WANG Hongxin, YANG Chaofan. Application of shortened replantation combined with limb lengthening in treatment of severe amputation of middle and distal lower leg. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(8): 936-940. doi: 10.7507/1002-1892.201703069 Copy

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2.	陳勁, 鐘華, 馬肅霜, 等. 骨縮短-延長技術在斷肢再植中的應用. 中華顯微外科雜志, 2016, 39(2): 182-184.
3.	劉亦楊, 沈立鋒, 郭峭峰, 等. 應用 Ilizarov 技術治療小腿下段斷肢再植術后肢體短縮. 中華創傷骨科雜志, 2016, 18(10): 908-912.
4.	王新宏, 鄭曉菊, 王保山, 等. 股前外側游離皮瓣在斷肢再植中的應用. 中華顯微外科雜志, 2013, 36(1): 97.
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7.	秦泗河, 夏和桃, 彭愛民, 等. 脛骨與跟腱同步彈性延長器的設計與臨床應用. 中華外科雜志, 2004, 42(19): 1157-1160.
8.	高順紅, 符健松, 張凈宇, 等. 股前外側螺旋槳皮瓣修復腹股溝皮膚軟組織缺損. 中華顯微外科雜志, 2017, 40(2): 123-125.
9.	王榮生, 許育東, 羅本環, 等. 經皮空心加壓螺釘與切開復位內固定修復單純內踝骨折: 關節功能恢復比較. 中國組織工程研究, 2015, 19(31): 5031-5035.
10.	任義軍, 嚴立, 胡銳, 等. Ilizarov 技術在治療脛骨骨與軟組織缺損中的應用. 中華創傷骨科雜志, 2017, 19(3): 213-218.
11.	董文濤, 彭吾訓, 周永芳, 等. Ilizarov 外固定架骨延長技術治療脛骨創傷性骨髓炎的效果分析. 廣東醫學, 2017, 38(4): 567-570.
12.	胡宏宇, 高順紅, 于志亮, 等. 一期游離組織瓣移植二期 Ilizarov 技術手術治療小腿大面積軟組織缺損并大段脛骨缺損. 中國骨與關節損傷雜志, 2017, 32(2): 160-163.
13.	藍霞. Ilizarov 牽張技術在肢體和骨段延長中的應用研究. 北京: 中國人民解放軍醫學院, 2013.
14.	Barwick TW, Montgomery RJ. Knee arthrodesis with lengthening: experience of using Ilizarov techniques to salvage large asymmetric defects following infected peri-articular fractures. Injury, 2013, 44(8): 1043-1048.
15.	康慶林. 髓內延長器家族中的新貴-Precise 釘. 中國矯形外科雜志, 2014, 22(17): 1627-1628.
16.	尚大財, 劉欽林, 鐘生財, 等. Ilizarov 骨滑移技術治療四肢長骨創傷性骨髓炎的臨床研究. 中國矯形外科雜志, 2016, 24(3): 220-225.
17.	劉敏, 朱志勇, 周玉虎. 小腿中下段斷肢再植術后肢體延長的臨床治療. 中華顯微外科雜志, 2003, 26(3): 232-233.

1. 曾文超. 復雜性大肢體離斷再植的臨床研究. 濟南: 濟南大學, 2015.
2. 陳勁, 鐘華, 馬肅霜, 等. 骨縮短-延長技術在斷肢再植中的應用. 中華顯微外科雜志, 2016, 39(2): 182-184.
3. 劉亦楊, 沈立鋒, 郭峭峰, 等. 應用 Ilizarov 技術治療小腿下段斷肢再植術后肢體短縮. 中華創傷骨科雜志, 2016, 18(10): 908-912.
4. 王新宏, 鄭曉菊, 王保山, 等. 股前外側游離皮瓣在斷肢再植中的應用. 中華顯微外科雜志, 2013, 36(1): 97.
5. 趙建強, 景斗星, 張軍, 等. 保留長度的一種小腿下段離斷再植修復方法. 中國骨與關節損傷雜志, 2009, 24(3): 265-267.
6. 侯建璽, 謝書強, 王宏鑫, 等. 前臂毀損離斷異位寄養二期回植再造一例. 中華手外科雜志, 2012, 28(3): 186-187.
7. 秦泗河, 夏和桃, 彭愛民, 等. 脛骨與跟腱同步彈性延長器的設計與臨床應用. 中華外科雜志, 2004, 42(19): 1157-1160.
8. 高順紅, 符健松, 張凈宇, 等. 股前外側螺旋槳皮瓣修復腹股溝皮膚軟組織缺損. 中華顯微外科雜志, 2017, 40(2): 123-125.
9. 王榮生, 許育東, 羅本環, 等. 經皮空心加壓螺釘與切開復位內固定修復單純內踝骨折: 關節功能恢復比較. 中國組織工程研究, 2015, 19(31): 5031-5035.
10. 任義軍, 嚴立, 胡銳, 等. Ilizarov 技術在治療脛骨骨與軟組織缺損中的應用. 中華創傷骨科雜志, 2017, 19(3): 213-218.
11. 董文濤, 彭吾訓, 周永芳, 等. Ilizarov 外固定架骨延長技術治療脛骨創傷性骨髓炎的效果分析. 廣東醫學, 2017, 38(4): 567-570.
12. 胡宏宇, 高順紅, 于志亮, 等. 一期游離組織瓣移植二期 Ilizarov 技術手術治療小腿大面積軟組織缺損并大段脛骨缺損. 中國骨與關節損傷雜志, 2017, 32(2): 160-163.
13. 藍霞. Ilizarov 牽張技術在肢體和骨段延長中的應用研究. 北京: 中國人民解放軍醫學院, 2013.
14. Barwick TW, Montgomery RJ. Knee arthrodesis with lengthening: experience of using Ilizarov techniques to salvage large asymmetric defects following infected peri-articular fractures. Injury, 2013, 44(8): 1043-1048.
15. 康慶林. 髓內延長器家族中的新貴-Precise 釘. 中國矯形外科雜志, 2014, 22(17): 1627-1628.
16. 尚大財, 劉欽林, 鐘生財, 等. Ilizarov 骨滑移技術治療四肢長骨創傷性骨髓炎的臨床研究. 中國矯形外科雜志, 2016, 24(3): 220-225.
17. 劉敏, 朱志勇, 周玉虎. 小腿中下段斷肢再植術后肢體延長的臨床治療. 中華顯微外科雜志, 2003, 26(3): 232-233.

Chinese Journal of Reparative and Reconstructive Surgery

Application of shortened replantation combined with limb lengthening in treatment of severe amputation of middle and distal lower leg

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