胫骨骨搬运后对合端不愈合的原因与治疗  

Causes and management of bone nonunion at the docking sites after tibial bone transport

作　　者：柴明祥[1] 臧建成[2] 吴天昊[1] 闫金成[1] 彭阿钦[1] 吴希瑞[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心、河北省骨科生物力学重点实验室,石家庄050051 [2]河北省沧州中西医结合医院骨科

出　　处：《中华创伤骨科杂志》2013年第10期840-844,共5页Chinese Journal of Orthopaedic Trauma

基　　金：河北省中医药管理局科研计划课题（2011152）

摘　　要：目的探讨胫骨骨搬运后对合端不愈合的原因与治疗方法。方法回顾性分析2006年1月至2012年1月应用骨搬运技术治疗的4Q例胫骨骨缺损、感染性骨不连、骨髓炎患者资料，男28例，女12例；年龄16—62岁，平均29。0岁。开放性胫骨骨折28例，闭合性胫骨骨折钢板固定术后感染12例。40例患者骨缺损长度为2～12cm，平均5．5cm。受伤至骨搬运时间平均为10．0个月。术后调整力线及骨搬运速度，患者坚持负重。结果40例患者术后获16—36个月（平均22．0个月）随访。19例患者对合端自然愈合；其余21例（52。5％）患者对合端未自然愈合，不愈合原因：对合端硬化11例，对接后断端接触面积小2例，对接后断端有皮肤及皮下组织嵌入3例，对合端明显错位3例，短缩后继发软组织畸形或骨质疏松2例。分别经手风琴技术（8例）、单纯植骨（2例）、植骨辅助内外固定（8例）、开放植骨（3例）相应处理后愈合。骨延长长度为2～12cm（平均5．2cm），外固定指数为1．4～2．3个月／cm（平均2．02个月／cm）。根据Paley等感染性骨不连、骨髓炎骨愈合评分标准评定骨性结果：优12例，良18例，中4例，差6例，优良率为75．0％。结论胫骨骨搬运对合端多不能自然愈合，在治疗过程中应同时处理软组织畸形及纠正下肢力线，并嘱患者坚持负重。即使对合端未自然愈合，最后根据情况选择手风琴技术、植骨等合适的方法也能使其愈合。Objective To explore the causes and management of bone nonunion at the docking sites after tibial bone transport. Methods From January 2006 to January 2012, tibial bone transport technique was used to treat 40 patients with tibial bone defect, infectious nonunion or osteomyelitis. They were 28 males and 12 females, aged from 16 to 62 years （average, 29. 0 years）. Twenty-eight cases were open tibial frac- tures and 12 closed tibial fractures with postoperative infection. The bone defects of the 40 patients averaged 5.5 cm, ranging from 2 to 12 cm. The average time from injury to bone transport was 10.0 months. The alignment and transport speed were adjusted after operation. Weight-bearing was encouraged in the patients. Results The 40 patients were followed up for 16 to 36 months （average, 22.0 months） postoperation. Spontaneous union of the docking sites was achieved in 19 cases but not in the other 21 cases （52.5%） . Causes included sclerosis of the docking sites in 11 cases, insufficient contact between the docking sites in 2 cases, embedding of skin or hypodermis into the docking sites in 3 cases, obvious malposition of the docking sites in 3 cases, and secondary soft tissue deformity or osteoporosis following shortening in 2 cases. They were treated respectively with the accordion technique （8 cases）, simple bone grafting （2 cases）, internal and external fixation combined with bone grafting （8 cases） and open bone grafting （3 cases）. Bone lengthening ranged from 2 to 12 cm （average, 5.2 cm）. External fixation index was from 1.4 month/cm to 2. 3 month/ cm （average, 2.02 month/cm） . According to Paley＇s evaluation criteria for infectious bone nonunion and osteomyelitis, 12 cases were excellent, 18 good, 4 moderate and 6 poor, giving a good to excellent rate of 75.0%. Conclusions A great number of tibial defects can not achieve spontaneous union at the docking sites after tibial bone transport. Normal soft tissue balance and correction of the lower limb alignment should be

关 键 词：胫骨 伊利扎罗夫技术 骨髓炎 骨折 不愈合 

分 类 号：R687.3[医药卫生—骨科学]