中国修复重建外科杂志

中国修复重建外科杂志

微创截骨 Ilizarov 技术结合髓内钉行股骨延长的疗效观察

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目的 探讨微创截骨 Ilizarov 技术结合髓内钉进行股骨延长治疗股骨短缩畸形的效果。 方法 将 2013 年 1 月—2016 年 6 月收治并符合选择标准的 71 例股骨短缩畸形患者,随机分为试验组(36 例,采用微创截骨 Ilizarov 技术结合带锁髓内钉进行股骨延长)和对照组(35 例,采用单纯 Ilizarov 技术进行股骨延长)。两组患者年龄、性别、股骨短缩原因、股骨短缩长度、股骨合并畸形比例等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、延长速度、外固定器佩戴时间、针道感染例数、截骨愈合时间、术后 1 年膝关节活动度。 结果 两组患者均获随访,随访时间 12~60 个月,平均 31 个月。试验组 1 例 1 针、对照组 7 例 9 针发生针道感染,均经更换固定针、积极换药、使用抗生素及加强护理后治愈;两组针道感染发生率比较差异有统计学意义(χ2=5.265,P=0.022)。试验组手术时间长于对照组,术中出血量大于对照组,外固定器佩戴时间、截骨愈合时间及术后 1 年膝关节活动度均优于对照组,差异有统计学意义(P<0.05);两组延长速度比较差异无统计学意义(t=–1.581,P=0.153)。 结论 微创截骨 Ilizarov 技术结合髓内钉进行股骨延长虽然增加了手术时间及术中出血量,但显著缩短了患者佩戴外固定器的时间,减少了针道感染概率,改善了术后关节功能。

Objective To explore the effectiveness of minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening. Methods Seventy-one patients with femoral shortening deformity who met the selection criteria between January 2013 and June 2016 were randomly divided into trial group (36 cases were treated with minimally invasive osteotomy Ilizarov technique combined with intramedullary nail for femoral lengthening) and control group (35 cases were treated with simple Ilizarov technique for femoral lengthening). There was no significant difference in age, gender, causes of femoral shortening, length of femoral shortening, rate of femoral deformity between the two groups (P>0.05). The operation duration, intraoperative blood loss, lengthening rate, external fixation duration, frequency of pin tract infection, osteotomy healing time, and range of motion (ROM) of knee at 1 year after operation were recorded and compared between the two groups. Results The patients of two groups were followed up 12-60 months (mean, 31 months). Pin tract infection occured in 8 cases (10 pins), including 1 case (1 pin) in the trial group and 7 cases (9 pins) in the control group. There was significant difference in the incidence of pin tract infection between the two groups (χ2=5.265, P=0.022). All patients were cured by replacing the fixation pins, changing dressing actively, application of antibiotics, and adequate postoperative care. The operation duration, intraoperative blood loss, external fixation duration, osteotomy healing time, and ROM of knee at 1 year after operation of the trial group were superior to those of the control group, showing significant differences (P<0.05). There was no significant difference in the lengthening rate between the two groups (t=–1.581, P=0.153). Conclusion The minimally invasive osteotomy Ilizarov technique combined with intramedullary nail in femoral lengthening increases the operation time, but the external fixation duration and incidence of pin tract infection are significantly reduced and the function of knee is significantly improved.

关键词: 股骨延长; 微创截骨; Ilizarov技术; 髓内钉; 外固定

Key words: Femoral lengthening; minimally invasive osteotomy; Ilizarov technique; intramedullary nail; external fixation

引用本文: 杨华清, 章耀华, 韩庆海, 彭爱民, 郑学建, 秦泗河, 夏和桃. 微创截骨 Ilizarov 技术结合髓内钉行股骨延长的疗效观察. 中国修复重建外科杂志, 2018, 32(12): 1524-1529. doi: 10.7507/1002-1892.201804118 复制

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