Orthofix重建外固定架治疗四肢长骨大段骨缺损的临床研究  

Clinical research on Orthofix limb reconstruction system for segmental defects in the long bones of the limbs

作　　者：孔圳[1] 孙永建[2] 李华龙[1] 左睿[1] 

机构地区：[1]广东医学院,湛江524023 [2]南方医科大学第五附属医院骨科,广州510900

出　　处：《中国骨与关节杂志》2015年第2期91-95,共5页Chinese Journal of Bone and Joint

基　　金：广东省医学科学技术研究基金(编号:WSTJJ20131227371326197105240016)

摘　　要：目的总结应用Orthofix重建外固定架治疗四肢长骨大段骨缺损方法并探讨其临床疗效。方法2009年1月至2013年9月,对我院收治的42例应用Orthofix重建外固定架治疗的四肢长骨大段骨缺损病例资料进行分析,其中男34例,女8例;年龄18～55岁,平均36.4岁。共有骨缺损部位43处,病种包括先天性胫骨假关节病、慢性骨髓炎、骨折术后骨不连、骨肿瘤、开放性粉碎性骨折等,经去除硬化骨、死骨后骨缺损4～21 cm,平均8.7 cm。对软组织较好患者行一期清理或截除骨段＋Orthofix重建外固定架骨搬运治疗,对伴有感染或软组织缺损患者经控制感染后行植皮或皮瓣转移-一期或二期Orthofix重建外固定架骨搬运治疗或者直接短缩-延长法治疗。于截骨术后第7～10天开始骨搬运,1 mm/天,均匀分4次。术前术后拍患肢正侧位X线片,记录患者骨搬运长度、外固定架佩戴时间,拆除外固定架后根据X线片计算骨痂直径率（callus diameter ratios,CDR）,根据Paley评分标准评价骨搬运结果及功能,根据肘关节Mayo、膝关节HHS、踝关节Baird-Jackson功能评分标准对术前术后关节功能进行评分,评价治疗效果。结果 42例均获得随访,随访时间10～48个月,平均16.5个月。本组患者经Orthofix重建外固定架骨搬运平均延长8.6 cm,平均外固定架固定时间15.4个月。41处骨缺损获得满意愈合,2处骨髓炎患者术后复发,经敞开持续冲洗、换药愈合。经Paley评分标准评价治疗结果,骨性结果评价：优40处,良3处。功能评价结果：优40处,良2处,差1处。拆除外固定后平均CDR值88.3%。治疗前肘关节1处Mayo评分63分、膝关节HHS评分平均（60.89±8.87）分、踝关节Baird-Jackson评分（64.12±6.21）分;治疗后肘关节1处Mayo评分88分、膝关节HHS评分（87±5.45）分、踝关节Baird-Jackson评分（87.67±5.32）分,各关节评分差异有统计学意义（P〈0.01）。结论 Orthofix重建外固定�Objective To summarize the methods of Orthofix limb reconstruction system in the treatment of segmental defects in the long bones of the limbs and to investigate the clinical results. Methods From January 2009 to September 2013, the clinical data of 42 patients with segmental defects in the long bones of the limbs who were treated with the Orthofix limb reconstruction system were collected and analyzed. There were 34 males and 8 females, whose average age was 36.4 years old（ range： 18-55 years）. There were 43 bone defect sites in all. Congenital tibial joint diseases, chronic osteomyelitis, nonunion, bone tumors and open and comminuted fractures were involved. The mean length of bone defects was 8.7 cm（ range： 4-21 cm） after debridement. One-stage debridement or segmental resection ＋ Orthofix limb reconstruction were performed on the patients with better soft tissues. Skin-grafting or transfer of skin flap ＋ one-stage or two-stage Orthofix limb reconstruction or shortening and lengthening technique after infection control were used for the patients with infections or soft tissue defects. Bone transport was performed at the 7th or 10 th day after osteotomy, with 1 mm / d and 4 times on average. The anteroposterior（ AP） and lateral X-rays were taken before or after the operation. The transport length and fixed time were noted. The callus diameter ratios（ CDR） were calculated based on the X-rays after removal of the external fixation. The results of bone transport and functions were evaluated by the Paley criteria. The preoperative and postoperative joint functions were graded by the Mayo elbow performance score（ MEPS）, Harris hip score（ HHS） and Baird-Jackson ankle function score systems, and the treatment outcomes were evaluated. Results All the patients were followed up for an average period of 16.5 months（ range： 10-48 months）. The average bone transport length was 8.6cm and the average fixed time was 15.4 months after the treatment of Orthofix limb reconstruction system. A

关 键 词：骨折固定术 骨重建 支架(骨科) 上肢骨 下肢骨 

分 类 号：R687.3[医药卫生—骨科学]