逆行带血管蒂腓骨Ⅰ期移植治疗胫骨下段感染性骨不连  

One-stage treatment of infected nonunion of the distal tibia with reverse-flow vascular pedicle fibular grafts

作　　者：厉孟[1] 蓝旭[1] 高秋明[1] 甄平[1] 李志琳[1] 高杰[1] 杨巧巧[1] 

机构地区：[1]兰州军区总医院创伤骨科,730050

出　　处：《中华创伤杂志》2015年第7期592-596,共5页Chinese Journal of Trauma

摘　　要：目的 探讨逆行带血管蒂腓骨Ⅰ期移植治疗胫骨下段感染性骨不连的效果.方法 2000年1月-2012年12月,共收治23例胫骨下段感染性骨不连患者,其中男13例,女10例;年龄26 ～ 59岁,平均38.7岁.感染性胫骨骨不连根据Jain-Sinha分类法分类：A型6例,B型17例.采用Ⅰ期清创,逆行带血管蒂同侧腓骨移植治疗.术后抗菌药物静脉滴注2～3周,口服4周.随访观察伤口愈合情况、患肢功能、患侧踝关节功能及移植腓骨的转归.结果 术后随访16～ 46个月,平均28.6个月.所有患者伤口未出现渗液、破溃等现象.1例术后出现腓骨骨折,经石膏外固定后骨折愈合,其余患者骨不连愈合良好;X线临床愈合时间为术后12 ～ 28周,平均15.6周.Ennecking系统术后患肢功能恢复（87±11）％,踝关节Olerud-Molander评分标准：优16例,良7例,优良率为100％.结论 逆行带血管蒂腓骨Ⅰ期移植治疗胫骨下段感染性骨不连手术操作简便,效果良好,是值得选择的治疗方法之一.Objective To measure the effect of one-stage transplantation of reverse-flow vascular pedicle fibular grafts in treatment of infected nonunion of the distal tibia.Methods From January 2001 to December 2012,23 patients sustaining the infected nonunion of the distal tibia were transplanted with reverse-flow vascular pedicled fibular grafts in one-stage.There were 13 males and 10 females,aged 26 to 59 years （mean,38.7 years）.Tibial nounion based on the Jain-Sinha classification was rated as Type A in 6 patients and Type B in 17 patients.After the operation,the patients received 2-3 weeks of intravenous antibiotic treatment and then 4-week oral antibiotic therapy.Wound healing,limb and ankle joint fucntion and outcomes in fibular transplantation were observed.Results Duration of follow-up was 16-46 months （mean,28.6 months）.There were no exudates and ulcerations of the skins.Smooth healing was achieved in all the patients except that fibular fracture was noted in one patient healed after cast immobilization.Healing time ranged from 12 to 28 weeks （mean,15.6 weeks）.Limb function evaluated with Ennecking system had （87 ± 11） % restoration.According the Olerud-Molander scoring system,ankle function was excellent in 16 patients and good in 7 patients,with the excellent-good rate of 100%.Conclusion One-stage reverse-flow vascular pedicle fibular grafting is an optional procedure for treatment of infected nonunion of the distal tibia,due to the technique is easy and effective.

关 键 词：感染 胫骨 骨移植 

分 类 号：R687.3[医药卫生—骨科学]