牵拉成骨技术结合胫距或胫跟融合术治疗踝关节周围感染性骨折不愈合  

Tibiotalar or tibiocalcaneal arthrodesis using the ilizarov technique in the presence of infected nonunions of ankle joints

作　　者：黄雷 王慎东 滕星[1] 杨胜松[1] 夏志林[3] 赵刚[1] 王陶[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]山东省新汶矿务局中心医院骨科 [3]武警北京总队第二医院骨科

出　　处：《中华外科杂志》2015年第6期405-409,共5页Chinese Journal of Surgery

基　　金：首都临床特色应用研究课题（Z121107001012006）

摘　　要：目的 总结应用混合外固定架进行胫骨运输术和延长术结合胫骨距骨融合术或胫骨跟骨融合术治疗踝关节周围感染性骨折不愈合的结果.方法 2003年4月至2013年3月对26例胫骨远端合并距骨和跟骨感染性骨折不愈合的患者实施混合式外固定架固定术、清创术.清创术后胫骨远段及踝关节前内侧创面2 cm×4 cm～4 cm×8 cm.二期行胫骨近段截骨运输术,待胫骨与距骨或跟骨对接后行胫距或胫跟融合术.对治疗结果进行回顾性分析.结果 患者均获得随访,随访时间22 ～ 38个月,平均32个月.胫骨近段截骨区新生骨长度为4～15 cm,平均8 cm.18例在对接端实施清创术,其中14例附加自体骨植骨术,3例合并腓骨缺损者直接短缩肢体,使胫骨与距骨加压,术后延长肢体至双下肢等长.待对接端骨折愈合、胫骨近段截骨运输处新生骨成熟后去除外固定架.平均带外固定架时间15个月.所有融合术均成功,感染无复发.2例在融合区出现6°内翻畸形.结论 胫骨牵拉成骨术结合胫距融合术或胫跟融合是治疗踝关节周围感染性骨折不愈合特别是大段骨缺损的一种有效治疗方法.Objective To evaluate the results of managing the infected nonunions of distal tibial fractures combined with talar fracture and calcaneal fracture with tibial bone transport,tibiotalar or tibiocalcaneal arthrodesis using the hybrid external fixator.Methods A retrospective review of 26 patients who underwent either tibiotalar arthodesis or tibiocalcaneal arthodesis using an hybrid external fixator for infected nonunions of distal tibial fractures,talar and calcaneal fractures after tibial bone distraction was made.Each patient had a debridement of all infected and nonviable bones,the wound area were 2 cm × 4 cm-4 cm × 8 cm.The bony surfaces of distal tibia and talus were prepared for the fusion followed by application of an Orthofix＆#39;s hybrid external fixator.Results The remaining 18 patients undertook debridement at the docking sites,and 14 of them had autogenous bone grafting.There was a mean follow-up of 32 months （22-38 months）.All the patients had successful fusions.There were no recurrent deep infections or amputations.Two patients had 6°of varus deformity at the docking site.Conclusion Tibiotalar or tibiocalcaneal arthrodesis using the Ilizarov technique is viable alternative to amputation in patients with infected nonunions,especially if there is a large bone loss of the tibias,talus and calcaneus.

关 键 词：骨折 不愈合 骨髓炎 踝 关节融合术 外固定器 

分 类 号：R687.3[医药卫生—骨科学]