Выбор методов фиксации костных фрагментов при аутопластике дефектов длинных трубчатых костей

Abstract

The aim of the study was to analyze the effect of different methods of fixing bone fragments after transplantation of the fibula into a large defect of long tubular bones on the results of treatment. The study included 10 patients (group 1) with major tibia defects in whom the method of postoperative fixation of the segment of the operated limb allowed to give an early mechanical load on the graft itself and 10 patients (group 2) where the impact of mechanical load on the graft was excluded due to its transplantation into the hummers defect (6 cases) or minimized when replacing the tibia defect (4 cases). The degree of graft hypertrophy, the rate of its fusion with the recipient bed, and the number of postoperative complications under different conditions of mechanical stimulation of the fibula graft were studied. The rate of fusion of the graft with the recipient bed in both groups of patients was the same, but the incidence of complete stress fractures of the fibula graft in the second group was three times higher than in the first and was 30%, against the background of a slight degree of graft hypertrophy (from 19% to 45%). The use of the Ilizarov device for fixing fragments of the post-resection bone bed and graft in a stable and dynamic mode allows to give an early postoperative load on the lower limb, stimulates the rate of graft hypertrophy and reduces the likelihood of developing complete stress fractures.