Bilateral Attached Bone Grafting

Bilateral attachment and bone grafting for the surgical treatment of congenital sacral pseudoarthrosis. Bilateral attachment bone grafting was created for Boyd. He believes that the bilateral cortical bone fixation is relatively strong, the line is good, can maintain a sufficient width of the humeral shaft, and can prevent the scar from compressing the implanted cancellous bone. If one side of the bone graft is absorbed, the contralateral bone graft still exists, and there is less possibility of fracture, and the cure rate is higher. However, this method is difficult to fix the distal bone graft of the lower humeral pseudoarticular joint. Tachdjian improved Boyd surgery. In addition to bilateral bone grafting, it was replaced with a pressor or intramedullary nail. This method not only solved the fixation problem of the lower humeral pseudoarticular joint, but also promoted bone healing. Curing disease: Indication 1, congenital sacral pseudoarthrosis has formed a pseudo-articular. 2. The age is over 3 years old. Contraindications 1. The cyst type and the anterior arch type have not yet formed a pseudo joint. 2, poor general condition or have important organ diseases. 3. There are infected lesions in the skin near the surgical area. Preoperative preparation 1. It is found that there is a pseudo-articular formation of the humerus, that is, it should be protected by a bracket to prevent the deformity from increasing and increasing the difficulty of surgery. 2, before the operation should be clear to the parents of the sick children, such malformation treatment is very difficult, the surgery is likely to fail, there may be multiple operations, and even the possibility of amputation. 3, the whole body to do the system, comprehensive inspection. 4. Prepare the skin 3 days before surgery. Surgical procedure 1. Incision An arcuate incision was made in the anterior aspect of the humerus, starting from the distal end of the tibial tuberosity and ending in the anterior aspect of the tibia along the posterior tibia. 2, remove the diseased tissue The subcutaneous and deep fascia were dissected, and the flap was freed forward and backward to protect the saphenous vein and saphenous nerve, revealing the pseudoarticular and diseased tissue. The extracellular periosteum is carefully separated and the soleus muscle and the long toe flexor are retracted backward to reveal the diseased tissue on the posterior side. Thoroughly remove the thickened fibrous tissue and periosteum surrounding the pseudoarticular joint. 3, dealing with bone ends Free bone ends, resected distal and proximal hardened bone tissue. Drill through and enlarge the distal and distal medullary cavity. Manipulative correction of the humerus forward angular deformity, and the healthy distal humerus and the proximal end of each other. Sometimes an incision is needed to extend the Achilles tendon to correct the deformity of the humerus. If the humerus is completely separated from the two ends of the humerus, another incision should be made to remove a segment of the humerus in order to align the two ends of the humerus. The tibia cut by intramedullary fixation with a retrograde nail. This also provides a good alignment and fixation for the broken end of the tibia. When manipulating the forward angular deformity, it is best to correct the humerus to a backward angle of 15 ° ~ 20 °. 4, bone grafting On the lateral and posterior sides of the distal and proximal humerus, a thin layer of cortex was drilled with a bone knife. The upper end was 5-7,5 cm proximal to the proximal end of the bone. The lower end was as close as possible to the distal humerus of the humerus, but it could not be damaged. Two pieces of periosteal bone flaps of corresponding size were cut from the contralateral humerus, and the upper and lower ends of the bone flap were drilled, attached to the rough surface of the prepared lateral and posterior tibial bones, and fixed to the distal and proximal ends of the humerus by non-absorbent suture. . The cancellous bone fragments and the cortical bones were implanted between the bone grafts and the pseudo joints. 5, internal fixation If the distal end of the humerus is long, the Sterling needle can be inserted into the lateral humerus at the distal end of the humerus at a distance of 1,25-2 cm and the proximal humerus, and fixed with a Charnley pressurizer to keep the two ends of the humerus firmly pressed and well. Counterpoint. If the distal radius of the humerus is short, the tibia can be fixed intramedullaryly with a thicker Sterling nail retrograde method. First, the Sterling nail is drilled from the distal end of the humerus to the distal end, through the distal epiphysis of the humerus, the ankle joint, the subtalar joint, and the calcaneus is worn out, and then the distal and proximal ends of the humerus are The nail is inserted into the proximal end of the humerus, and the ideal direction of the nail should be such that the proximal end of the nail is just in the posterior cortex of the tibia. The distal tip is buried under the skin. 6, stitching Rinse the wound, completely stop bleeding, suture the calf triceps, tibialis anterior muscle to the tibia, suture the skin, skin. complication 1. Forming a pseudo joint again The cause is that the lesion is not resected, the autogenous bone graft is not used, the internal fixation is not strong or the fixation time is not enough, the plaster is improperly fixed, the local blood circulation is poor, and the age at the time of surgery is too small. Follow the above-mentioned intraoperative attention points and post-operative treatment items, which can improve the success rate of surgery. Regular follow-up should be performed after surgery. If the original structure of the pseudo-articular tissue is found to have regeneration, it should be removed before the bone changes occur. If the bone ends of the original pseudo joints are hardened, sometimes even if there is no trauma, fatigue fractures may occur. If a bone crack is found on the X-ray film, it is a precursor to the pseudo joint, and the bone should be replanted in time. The re-formation of the pseudo-joint should be treated with a vascular free iliac bone graft, which can be successful. 2, calf shortening Such malformations are often accompanied by calf shortening, intraoperative resection of the distal, proximal hardened bone ends, the postoperative calf has a certain shortening. If the patient is younger, the tibia is connected. As the age increases, the calf can gradually grow, so that the legs are gradually reduced in length, or even become equal or small, and need not be treated. If the limbs are not equal in length, the contralateral limb osteophyte fusion can be performed at an appropriate age. If the limb is shortened too much, accompanied by severe foot deformity, unable to complete the weight-bearing function, you can also consider amputation, with prosthetic limbs, improve function. In the bone grafting, the healthy bone should be preserved as much as possible when the bone end is removed. The bone defect in the bone defect is beneficial to reduce the shortening of the calf. 3, ankle valgus deformity Surgical injury to the distal radius of the humerus can be complicated by ankle valgus deformity. In the adolescence, the distal metaphyseal fusion of the humerus can be performed (Langenskiod surgery); after the bone is mature, osteotomy can be corrected. 4, infection Preoperative skin preparation, strict aseptic operation during surgery, complete hemostasis, antibiotics before and after surgery can prevent infection. If an infection occurs, it is easy to form osteomyelitis. In addition to the application of a large number of broad-spectrum antibiotics, the wounds are drained in time, and the antibiotic solution is dripped and wet. If the infection cannot be controlled, the internal fixation and the bone graft are removed, and the bone graft is performed 1 year after the wound is healed.

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