骨搬移术治疗胫骨骨折术后感染性大段骨缺损的疗效分析  

Curative effect of bone transport for infectious large segmental bone defect after surgical treatment for tibial fracture

作　　者：郝光亮[1] 张贵春[1] 曹学成[1] 

机构地区：[1]中国人民解放军济南军区总医院,济南250031

出　　处：《中国骨与关节外科》2014年第5期370-373,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景：胫骨骨折术后感染性大段骨缺损的发生率高,治疗困难,效果不理想。目前,骨缺损修复方法包括皮瓣覆盖＋自体骨移植术、异体骨或异种骨移植、带血供腓骨移植、骨延长和骨搬移术。目的：探讨骨搬移术治疗胫骨骨折术后感染性大段骨缺损的疗效。方法：选取2010年9月至2014年9月收治的胫骨骨折术后感染性大段骨缺损患者40例,男24例,女16例;年龄18~64岁,平均（42.8±12.1）岁。将患者随机分成两组各20例,一组采用Orthofix单臂外固定延长架截骨延长,另一组采用Ilizarov环形外固定延长架截骨延长,术后随访对比两组患者的手术时间、手术出血量、HHS膝关节功能评分、Baird-Jackson踝关节功能评分。结果：Orthofix单臂外固定延长架的手术时间较短、手术出血量较少,与Ilizarov环形外固定延长架比较均有统计学差异（P〈0.05）。两组患者的术后HHS膝关节功能评分、Baird-Jackson踝关节功能评分均较术前有明显提高（P〈0.01）。结论：骨搬移术治疗胫骨骨折术后感染性大段骨缺损的疗效佳,可较好地改善患者的膝关节和踝关节功能。其中Orthofix单臂外固定延长架能减少手术创伤,安全性较高,但骨搬运过程中容易发生延长骨成角和偏移;Ilizarov环形外固定延长架的术中应用置入较多钢针,移动时可造成部分皮瓣坏死和血管损伤,应避免在皮瓣覆盖创面的胫骨大段骨缺损患者中使用。Background： There are high incidences of infectious large segmental bone defect after surgical treatment for tibial fracture, and it is very difficult to be cured. At present, there are a few of methods for repairing bone defect, such as skin flap cover- age plus autogenous bone transplantation, allograft bone or xenogeneic bone transplantation, vascularized fibular graft, bone lengthening and bone transport technique. Objective： To explore the curative effect of bone transport technique in treating infectious large segmental bone defect after surgery for tibial fracture. Methods： Forty patients with infectious large segmental bone defect after tibial fracture operation admitted to our hospital from September 2010 to September 2014 were enrolled in the study and randomly divided into two groups. Osteotomy was performed in group A by Orthofix external fixing lengthening, and osteotomy was performed in group B by Ilizarov ring fix- ing lengthening. Operation time, blood loss, HHS knee function score, Baird-Jackson ankle function score were compared between groups. Results： Compared to those in Ilizarov group, the operation time was significantly shortened and intraoperative blood loss was significantly decreased （P〈0.05）. HHS knee function score and Baird-Jackson ankle function score were significantly increased after surgery in all patients （P〈 0.01）. Conclusions： The bone transport technique can achieve good curative effect on infectious large segmental bone defect after tibial fracture operation. Both Orthofix external fixing lengthening and Ilizarov ring fixing lengthening can improve the knee and ankle joint function. The former can reduce the operation trauma and increase operation safety, but malunion and offset may occur in the procedure. More intraoperative needles will be implanted in Ilizarov lengthening, and skin flap ne- crosis and vascular injury may occur when moving. So it can not be used in the patients with large segment bone defect of tibia and the wound covered with skin fl

关 键 词：骨搬移术 胫骨骨折 感染 大段骨缺损 延长架 

分 类 号：R687.3[医药卫生—骨科学]