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Re: Исход остеолиза локтевой кости
послал Myles Clough 08 Ноябрь 2003, 13:39
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Massive Osteolysis (AKA Gorham's) is perennially fascinating. This case is very similar to the one I inherited after successful treatment of the original presentation with a vascularised free fibular graft.
The free fibular graft worked well in that case and I wonder if it wouldn't be the correct thing to do in your case combined with gradual reduction of the dislocation. Certainly I cannot see how the reduction could be maintained long term unless the ulna was reconstructed. The question of how much better the patient's finction would be even with successful surgery is really difficult. I would stress potential improvements in strength rather than any promises about range of motion.
Against interference would be the unknown nature of the underlying condition. If surgery to implant a fibular graft sets off a new process of osteolysis you could make him worse and lead to an amputation. I don't believe anyone in the world has enough experience with these sorts of cases
to say what will happen.
Myles Clough mylesclough@shaw.ca
Orthopaedic Surgeon, Kamloops, BC, Canada
Clinical Instructor, University of British Columbia
President, Internet Society of Orthopaedic Surgery and Trauma
http://www.isost.com
Editor, OWL (Orthopaedic Web Links) http://www.orthopaedicweblinks.com
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