大腿骨遠位開放骨折による骨欠損に対して骨移動術で再建を行った1例

Use of the Ilizarov Method for Treatment of Traumatic Femoral Segmental Bone Defect

　全周性骨欠損を伴う大腿骨顆上部開放骨折をIlizarov創外固定器による骨移動術で再建した．Distraction indexは13.6日/cm，external fixation indexは36.6日/cmで良好な骨癒合が得られたが，膝関節拘縮を生じたため観血的関節授動術を行った．骨欠損に対する骨移動術は健常組織の犠牲なく組織新生により同径の骨を再生することができる．骨移動術の合併症で関節可動域制限が知られており，創外固定器の固定方法の工夫や装着直後からの積極的な理学療法が必要であると考えられる．

　A compound supracondylar femoral fracture with accompanying circumferential bone defects was reconstructed by bone transport using an Ilizarov external fixator.　Favorable bone union was obtained with an external fixation index of 36.6 days/cm and a distraction index of 13.6 days/cm, although open-joint mobilization was performed after the development of knee flexion contracture.　Utilizing bone transport for the treatment of bone defects enabled successful regeneration of bone having an identical diameter from new tissue, without sacrificing normal tissue.　Limited range of joint motion is a complication of external fixation, and ingenious methods for external fixator attachment and physical therapy immediately after attachment are believed necessary in this treatment modality.