骨搬移技术治疗下肢感染性骨缺损  

Bone transport technique in treatment of infectious bone defect of lower limbs:report of 26 cases

作　　者：李维[1] 王子明[1] 杜全印[1] 王雨[1] 熊雁[1] 王爱民[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所关节四肢外科,重庆400042

出　　处：《第三军医大学学报》2015年第3期267-270,共4页Journal of Third Military Medical University

摘　　要：目的探讨应用骨搬移技术治疗严重下肢感染性骨不连的临床疗效。方法按照牵拉组织再生原理,对26例四肢高能量损伤后下肢感染性骨不连患者采取病灶彻底切除＋干骺端截骨搬移术。术后7 d以0.25 mm/6 h速度延长,固定延长至骨缺损端会合,于骨缺损处两断端加压并继续维持外固定支架至骨愈合。结果 26例全部获随访,平均随访56（20～92）个月。骨延长2～14 cm,平均5.5 cm,骨性感染全部治愈。带支架时间6～24个月,平均13个月。23例骨缺损处及延长部位骨生长良好,达到了骨性愈合;3例断端骨接触后6个月无明显骨愈合,其中2例行自体髂骨植骨,1例拆除支架后行自体髂骨植骨内固定,4～6个月达到骨性愈合。截骨延长部位及骨缺损对合处对位对线良好。结论骨搬移技术治疗下肢感染性骨不连,术后感染控制良好,骨愈合率高。Objective To investigate the clinical efficacy of bone transport technique in the treatment of severe lower extremity infected bone nonunion. Methods A total of 26 patients with lower limb long bone nonunion due to severe infection admitted in our department from the years of 2006 to 2012 were enrolled in this study. According to the principle of distraction histogenesis,they were treated by complete focal excision and metaphyseal osteotomy transport technique. In 7 d after surgery,the transported bone graft was extended in a speed of 0. 25 mm per 6 hours to fill bone defect. The pressure outside the fixed bracket was maintained to the bone defect between the 2 ends till the bone healing. Results All the 26 cases were followed up for a duration of 20 to 92 months（ average 56 months）. The transported bone graft was lengthened for 2 to 14 cm（ average 5. 5 cm）. Bony infection was cured. They were with support for 6 to 24 months（ average 13months）. Twenty-three cases had the bone defect and prolonged bone growth well and achieved bony union.There were 3 cases having bone exposure,with broken ends without obvious bone healing in 6 months after surgery. Two of them underwent autologous iliac bone grafting. One case received autologous iliac bone graft and internal fixation after stent removal,and achieved bone healing n 4 to 6 months later. Sound linear and positional alignments were observed in the osteotomy sites and bone defects. Conclusion Bone transport technique achieves well controlled infection after operation and high rate of bone union in the treatment of lower limb bone nonunion due to infection.

关 键 词：骨搬移 骨延长 骨髓炎 外固定 

分 类 号：R681.2[医药卫生—骨科学] R683.42[医药卫生—外科学]