单边外固定支架与环形外固定支架骨搬运治疗下肢长干骨缺损的疗效及并发症比较  

Bone transport for lower limb bone defects： circular versus monolateral external fixators

作　　者：成亮[1] 徐佳[1] 柴益民[1] 钟万润 汪春阳[1] 韩培[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤骨科杂志》2015年第10期863-867,共5页Chinese Journal of Orthopaedic Trauma

基　　金：基金项目：上海市科委课题（11JC1409400）

摘　　要：目的比较单边外固定支架与环形外固定支架骨搬运治疗下肢长干骨骨缺损的疗效及并发症情况。方法回顾性分析2011年1月至2013年4月收治的42例下肢长干骨骨缺损患者资料，其中20例采用单边外固定支架进行骨搬运治疗（单边组），男14例，女6例；年龄20。53岁，平均31．6岁；股骨缺损10例，胫骨缺损10例。22例采用环形外固定支架进行骨搬运治疗（环形组），男13例，女9例；年龄16—56岁，平均33．6岁；股骨缺损5例，胫骨缺损17例。记录并比较骨折愈合时间、并发症情况等，并按照Paley提出的评价标准评定疗效。同时根据Paley提出的分类标准统计并发症情况。结果所有患者术后平均20．3个月（6—38个月）随访，所有患者的延长段和对合端均达骨性愈合。单边组与环形组骨愈合指数（愈合时间／缺损长度）平均为（1．8±0．4）、（1．6±0．3）个月／cm，差异无统计学意义（P〉0．05）。末次随访时根据Paley等提出的评价标准评定疗效，骨性结果：单边组优17例，良3例；环形组优20例，良2例。功能结果：单边组优17例，良3例；环形组优16例，良6例。两组患者骨性结果、功能结果、次要并发症、主要并发症和真正并发症的发生次数比较差异均无统计学意义（P〉0．05）。结论两种外固定支架都可以用来治疗下肢长干骨缺损。对于下肢股骨缺损的治疗，患者更能耐受单边外固定支架；但对于复杂、需要在治疗过程中进行调节的长干骨缺损，环形外固定支架更具优势。Objective To compare circular and monolateral external fixators used for bone transport in the treatment of lower limb bone defects. Methods From January 2011 to April 2013, 42 patients with lower limb bone defects were treated in our department. Monolateral external fixator was used for bone transport in 20 patients. They were 14 males and 6 females, with a mean age of 31.6 years （from 20 to 53 years） . Ten cases bad femoral defects and 10 tibial defects. Circular external fixator was used for bone transport in the other 22 patients. They were 13 males and 9 females, with a mean age of 33.6 years （from 16 to 56 years） . Five cases had femoral defects and 17 tibia1 defects. Time for fracture union, complications, and Paley＇ s criteria for bony and functional recovery were documented. Results All the patients were followed up for 6 to 38 months （mean, 20.3 months）. Bony union as achieved between all the bone segments. There were no significant differences between the 2 groups in the bone union index （1.8± 0. 4 m/cm versus 1.6 ±0.3 m/cm） （ P 〉 O. 05）. By the Paley＇s criteria for bony recovery, 17 cases were excellent and 3 fine in the monolateral fixator group while 20 were excellent and 2 fine in the circular fixator group. By Paley＇s criteria for functional recovery, 17 cases were excellent and 3 fine in the monolateral fixator group while 16 were excellent and 6 fine in the circular fixator group. By the Paley＇ s criteria, there were no significant dif- ferences between the 2 groups with regard to secondary, primary and real complications （ P 〉 0. 05 ） . Conclusions Both circular and monolateral external fixators are effective in bone transport to treat lower limb bone defects. The monolateral fixator is more tolerable for patients with femoral defects. The circular fixator is more advantageous for patients with complex long shaft defects because it allows for deformity corrections during bone transport.

关 键 词：外固定器 骨延长术 手术后并发症 ILIZAROV技术 

分 类 号：R687.3[医药卫生—骨科学]