中国修复重建外科杂志

中国修复重建外科杂志

Ilizarov 技术修复创伤后桡骨远端畸形并骨缺损

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目的探讨 Ilizarov 技术修复创伤后桡骨远端畸形伴骨缺损的疗效。方法回顾性分析 2012 年 1 月—2016 年 12 月,应用 Ilizarov 技术治疗 9 例创伤后桡骨远端畸形伴骨缺损患者临床资料。其中男 7 例,女 2 例;年龄 11~46 岁,平均 25.6 岁。其中 4 例桡侧棒球手畸形并大段骨缺损,4 例桡骨远端短缩桡偏畸形,1 例桡骨远端短缩并尺桡骨桡偏弯曲旋前畸形,均伴有下尺桡关节背侧脱位。受伤至此次手术时间为 6 个月~6.2 年,平均 1.5 年。骨缺损长度(桡骨短缩畸形骨缺损按短缩计算)1.4~6.8 cm,平均 3.6 cm。彻底清创后以 Ilizarov 环式外固定架固定,术后 7 d 以 0.8~1 mm/d 速度进行骨搬移或骨延长,分 4 次完成,缓慢矫正畸形并修复骨缺损;并根据术前测量掌倾角及尺偏角的丢失,在搬移或延长过程中逐渐调整桡骨远端关节面位置,以尽量恢复掌倾角及尺偏角。结果所有患者伤口均Ⅰ期愈合,未出现渗液、破溃等现象。9 例患者均获随访,随访时间 15~36 个月,平均 23 个月。桡骨骨缺损全部愈合,远端畸形矫正,愈合时间 92.4~138.6 d,平均 104.7 d;外固定指数 32.6~51.1 d/cm,平均 40.2 d/cm。外固定拆除术后 2 个月腕关节屈曲(42.6±3.1)°、背伸(48.5±4.7)°,掌倾角(11.5±1.3)°,尺偏角(21.2±3.7)°;肘关节屈曲(128.2±6.4)°、背伸(3.2±2.1)°;前臂旋前(71.5±4.3)°、旋后(38.2±6.5)°;腕、肘关节背伸及前臂旋后均较术前显著改善(P<0.05)。末次随访时,按 Gartland-Werley 标准评定腕关节功能,获优 3 例,良 5 例,可 1 例。4 例出现针孔感染,抗炎换药或更换针后治愈。3 例骨对接处未愈合,行植骨愈合;4 例桡骨力线偏移,换针调整后畸形矫正。结论Ilizarov 技术能同期矫正创伤后桡骨远端畸形并修复骨缺损,是治疗此类疾病的良好方法。

ObjectiveTo investigate the effectiveness on the distal radius deformity and bone defect after trauma by using Ilizarov external fixator.MethodsThe clinical data of 9 patients of post-traumatic distal radius deformity with bone defect treated by Ilizarov technique between January 2012 and December 2016 were retrospectively analyzed. There were 7 males and 2 females with an average age of 25.6 years (range, 11-46 years). Of the 9 cases, 4 were radial baseball hand deformity with large bone defect, 4 were short deformity of distal radius, 1 was distal radius deformity with radial deflection and pronation deformity, all with distal dislocation of the distant radial-ulnar joint. The time from injury to operation was 6 months to 6.2 years (mean, 1.5 years). The bone defect was 1.4-6.8 cm (mean, 3.6 cm). After complete debridement, the forearm was fixed with Ilizarov external fixator. At 7 days after operation, bone transport or bone lengthening was performed at the rate of 0.8-1 mm/d, 4 times a day, the deformity was slowly corrected and the bone defect was repaired. According to the loss of palmar tilt angle and ulnar tilt angle measured before operation, the position of distal radial articular surface was gradually adjusted in the course of moving or prolonging, so as to restore palmar tilt angle and ulnar tilt angle as far as possible.ResultsAll wounds healed by first intention and no leakage or rupture occurred. All the 9 patients were followed up 15-36 months (mean, 23 months). All the radius defects healed and the distal deformity was corrected, the healing time was 92.4-138.6 days (mean, 104.7 days); the external fixation index was 32.6-51.1 days/cm (mean, 40.2 days/cm). After 2 months of external fixator removal, the wrist joint flexion was (42.6±3.1)°, the wrist dorsum extension was (48.5±4.7)°, the palm inclination angle was (11.5±1.3)°, and the ulnar deviation angle was (21.2±3.7)°; the elbow flexion was (128.2±6.4)°, the elbow extension was (3.2±2.1)°, the forearm pronation was (71.5±4.3)°, and the forearm rotation was (38.2±6.5)°; the wrist and elbow joint extension and forearm rotation were significantly improved when compared with preoperative values (P<0.05). At last follow-up, wrist function was assessed according to Gartland-Werley standard, the results were excellent in 3 cases, good in 5 cases, and fair in 1 case. Four cases had pinhole infection, and were cured after anti inflammatory dressing change or replacement of needles; 3 cases did not heal at the bone junction, and were healed after bone grafting; 4 cases deviated from the radial force line, and the deformity was corrected after adjusting the needle.ConclusionIlizarov technique can correct deformity and reconstruct bone defect of the post-traumatic distal radius simultaneously, so it is a good method to treat this kind of disease.

关键词: 桡骨远端骨折; 畸形; 骨缺损; Ilizarov 技术

Key words: Distal radius fracture; deformity; bone defect; Ilizarov external fixatoin

引用本文: 厉孟, 刘锐, 高杰, 蓝旭, 王振军, 高秋明, 甄平. Ilizarov 技术修复创伤后桡骨远端畸形并骨缺损. 中国修复重建外科杂志, 2018, 32(10): 1275-1280. doi: 10.7507/1002-1892.201804088 复制

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