Ilizarov技术治疗Cierny—Mader Ⅲ、Ⅳ型胫骨创伤性骨髓炎的疗效评价  

Ilizarov bone transportation to treat tibial traumatic osteomyelitis of Cierny-Mader types Ⅲ and Ⅳ

作　　者：任义军[1] 严立[1] 胡锐[1] 丁凡[1] 涂松[1] 勘武生[1] 郑琼[1] 

机构地区：[1]华中科技大学同济医学院附属普爱医院骨科,武汉430033

出　　处：《中华创伤骨科杂志》2013年第10期845-848,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用Ilizarov技术治疗Cierny—MaderⅢ、Ⅳ型胫骨创伤性骨髓炎的疗效。方法回顾性分析2008年3月至2012年12月收治的47例胫骨创伤性骨髓炎患者资料，男33例，女14例；年龄18—61岁，平均35．9岁。胫骨骨髓炎根据Ciemy—Mader解剖学分型：Ⅲ型17例，Ⅳ型30例。开放性骨折35例，闭合性骨折12例；41例患者伴有死骨窦道形成和钢板外露，17例患肢有短缩的内、外翻畸形。31例患者胫前伴有皮肤软组织缺损，缺损面积为4cm×3cm-16cm×8cm。采用病灶骨段切除、Ilizarov技术骨段延长结合清创、植骨、内固定等治疗。记录患者的骨段延长长度、外固定时间、骨愈合及功能评价结果，并应用Spearman秩检验分析其相关性。结果47例患者术后获13—41个月（平均24．6个月）随访。本组患者延长长度平均为6．4cm，外固定时间平均为232．3d；骨搬运速度平均为12．6d／cm；平均外固定指数为37．8d／cm。46例患者获骨性愈合，1例感染复发。根据Paley治疗感染性胫骨骨不连改良评分标准，骨性结果：优36例，良9例，可1例，差1例，优良率为95．7％；功能结果：优24例，良16例，可6例，差1例，优良率为85．1％。延长长度与骨愈合、功能恢复等级均呈负相关（P〈0．05）；外固定时间与功能恢复呈负相关（P〈0．05）。结论Ilizarov技术是一种治疗Cierny．MaderⅢ、Ⅳ型胫骨创伤性骨髓炎的有效方法。Objective To discuss clinical outcomes of Ilizarov technique in the treatment of tibial traumatic osteomyelitis of Cierny-Mader types Ⅲ and Ⅳ . Methods From March 2008 to December 2012 we treated 47 patients with tibial traumatic osteomyelitis. They were 33 men and 14 women, aged from 18 to 61 years （average, 35.9 years） . According to the Cierny-Mader anatomical classification, the osteomyelitis was of type Ⅲ in 17 cases and of type Ⅳ in 30. Thirty-five patients had open fractures and 12 closed ones. Forty-one patients were complicated with sinus tract formation in the dead bone and plate exposure, and 17 patients with shortened varus and valgus. Thirty-one patients were complicated with skin and soft tissue defects at the anterior tibia. The areas of defects ranged from 4 cm - 3 cm to 16 cm - 8 cm. They were treated by resection of the lesion segments and Ilizarov bone lengthening combined with debridement, bone grafting and internal fixation. Bone lengthening distance, external fixation time, bone healing and functional recovery were recorded and analyzed with Spearman rank correlation statistics. Results The 47 patients were followed for 13 to 41 months （average, 24. 6 months） . The average bone lengthening in this series was 6.4 era, the external fixation time 232. 2 days, the bone transport speed 12. 6 d/cm, and the external fixation index 37.8 d/cm. Bony union was obtained in 46 patients and re-infection occurred in one. According to the modified Paley＇s criteria for bone healing, 36 cases were excellent, 9 good, one moderate and one poor, with an ex- cellent to good rate of 95.7%. The functional recovery was rated as excellent in 24 cases, good in 16, moderate in 6 and poor in one, giving an excellent to good rate of 85. 1%. The lengthening distance was negatively related to the bone healing and functional recovery levels （ P 〈 0. 05） while the external fixation time was negatively related to the functional recovery（ P 〈 0. 05） . Conclusion The Ilizarov bone transport is an

关 键 词：骨髓炎 胫骨 伊利扎罗夫技术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]