中国修复重建外科杂志

中国修复重建外科杂志

单边外固定支架联合钢板内固定行骨搬运术治疗胫骨感染性骨不连

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目的 探讨单边外固定支架联合钢板内固定行骨搬运术治疗胫骨感染性骨不连的临床疗效。 方法 2010 年 1 月—2014 年 12 月,采用单边外固定支架联合钢板内固定行骨搬运术治疗 23 例胫骨感染性骨不连患者。其中男 19 例,女 4 例;年龄 19~54 岁,平均 37.8 岁。感染骨段切除后骨缺损长度为 5.2~8.1 cm,平均 6.5 cm。既往手术 2~4 次,平均 2.5 次。受伤至此次治疗时间为 7~23 个月,平均 11.8 个月。记录骨搬运时间、外固定时间、骨折愈合时间、外固定指数、愈合指数和并发症。采用 Ilizarov 方法应用研究学会(ASAMI)骨愈合和功能评价标准评估疗效。 结果 23 例患者均获随访,随访时间 3~6 年,平均 4.8 年。所有患者创面及骨缺损均愈合,未出现感染复发、骨不连、再骨折、畸形愈合、医源性神经麻痹、膝关节或踝关节僵硬等并发症。5 例出现钉道感染,经局部护理后未出现深部感染。骨搬运时间 65~120 d,平均 75.6 d;外固定时间 75~145 d,平均 97.8 d;骨折愈合时间 4~17 个月,平均 8.7 个月;外固定指数 18~28 d/cm,平均 22.4 d/cm;愈合指数 31~52 d/cm,平均 40.2 d/cm。末次随访时,根据 ASAMI 评价标准,骨愈合达优 15 例、良 8 例,功能达优 18 例、良 5 例,优良率均为 100%。 结论 采用单边外固定支架联合锁定钢板内固定行骨搬运术治疗胫骨感染性骨不连,可减少外固定器使用时间和与之相关的并发症,临床疗效满意。

Objective To summarize the effectiveness of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion. Methods Between January 2010 and December 2014, 23 patients with infected tibial nonunion were treated with bone transport with unilateral external fixator combined with locked plate internal fixation. There were 19 males and 4 females with an average age of 37.8 years (range, 19-54 years). The mean length of the bone defect was 6.5 cm (range, 5.2-8.1 cm). The number of previous operations ranged from 2 to 4 times, with an average of 2.5 times. The time from injury to this treatment was 7-23 months, with an average of 11.8 months. The time of bone transport, time of the external fixation, fracture healing time, external fixation index, healing index, and complication were recorded; and the Association for the Study and Application of the Methods of Ilizarov (ASAMI) bone healing and function scores were used to evaluate the effectiveness. Results All patients were followed up 3-6 years with an average of 4.8 years. Wounds and bone defects healed in all patients. No complication such as infection recurrence, nonunion, re-fracture, malunion, iatrogenic nerve paralysis, or stiffness of knee and ankle joints occurred. Five patients had needle infections which were treated by local care and no deep infection occurred. The time of bone transport was 65-120 days (mean, 75.6 days); the time of the external fixation was 75-145 days (mean, 97.8 days); the fracture healing time was 4-17 months (mean, 8.7 months); the external fixation index was 18-28 days/cm (mean, 22.4 days/cm); and the healing index was 31-52 days/cm (mean, 40.2 days/cm). At last follow-up, according to ASAMI criteria, the result of bone healing was excellent in 15 cases and good in 8 cases, and the result of function was excellent in 18 cases and good in 5 cases, all with the excellent and good rate of 100%. Conclusion For infected tibial nonunion, bone transport with unilateral external fixator combined with locked plate internal fixation can reduce the time of external fixation and related complications, with a satisfactory effectiveness.

关键词: 胫骨; 感染性骨不连; 骨搬运术; 骨缺损

Key words: Tibia; infected nonunion; bone transport; bone defect

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