单边外固定架骨搬移联合白体植骨治疗下肢创伤性慢性骨髓炎  

Bone transport technigue using mono-lateral external fixator plus bone grafting for treatment of posttraumatic chronic osteomyelitis of lower limbs

作　　者：刘军 罗利芳[3] 张寿涛[2] 王鲁博[3] 张琰[3] 范文闯[3] 王润泽[3] 穆卫东[3] 

机构地区：[1]山东省阳信县人民医院外科,251800 [2]滨州医学院附属医院骨科 [3]山东大学附属省立医院创伤骨科

出　　处：《中华创伤杂志》2016年第3期229-233,共5页Chinese Journal of Trauma

摘　　要：目的探讨单边外固定架骨搬移技术联合自体植骨治疗下肢创伤性慢性骨髓炎的临床效果。方法回顾性分析2008年9月-2014年9月收治的股骨或胫腓骨骨折术后慢性骨髓炎患者18例，均行单边外固定架骨搬移技术治疗，其中9例在骨搬移后行自体髂骨植骨钢板或髓内钉内固定术。采用骨愈合指数（BHI）评估新生骨的骨化情况，采用Paley评分评估疗效。结果患者均获随访10-24个月，平均13．5个月。均愈合良好及感染彻底控制，总的愈合时间（46．3±10．3）周，其中行自体髂骨植骨钢板或髓内钉内固定患者临床愈合时间更短[（41．4±10．4）周]（P〈0．05）。从骨搬移至去除外固定架的治疗周期为（42．9±13．0）周，而自体髂骨植骨钢板或髓内钉内固定患者为（34．7±11．8）周（P〈0．01）；总BHI为（1．9±0．6）m／cm，自体髂骨植骨钢板或髓内钉内固定患者BHI为（1．4±0．4）m／cm（P〈0．01）。根据Paley评分标准，骨性结果：优15例，良3例；功能结果：优9例，良6例，一般3例。5例存在钉道问题，3例钉道处骨感染，2例延迟愈合，3例关节僵硬，5例调整固定针，其中3例畸形愈合。结论单边外固定架骨搬移技术是治疗创伤性慢性骨髓炎的有效方法，自体髂骨植骨内固定术可有效缩短外固定时问及总愈合时间。Objective To review the results of bone transport using a unilateral external fixator plus autografts for treatment of posttraumatic chronic osteomyelitis of lower limbs. Methods A retrospective analysis was made of 18 patients sustaining posttranmatie chronic osteomyelitis following femoral or tibiofibular fracture between September 2008 and September 2014. After bone transport with a unilateral external fixator in all, 9 had antologous ilium hone grafting and plate osteosynthesis. Ossification of new bone was assessed by bone healing index（BHI）. Outcome was assessed by Paley score. Results At the follow-up of 10-24 months （ mean, 13.5 months） , union was achieved and infection was eradicated in all patients. Period of bone union was （46.3 ± 10.3）weeks in all, but a relatively much shorter period of time [ （41.4 ± 10.4）weeks] was observed in patients with autologous bone grafting. Duration from hone transport to removal of external fixator was （42.9 ±13.0） weeks in all, and was （ 34.7 ± 11.8 ） weeks in patients with autologous bone grafting. BHI was （ 1.9 ± 0.6） m / cm in all, and was （ 1.4±0.4） m/cm in patients with autologous bone grafting. According to the Paley score, bone results were excellent in15 patients and good in 3 patients, and functional results were excellent in 9 patients, good in 6 patients and fair in 3 patients. Pin-tract infection occurred in 5 patients, bone infection in 3, delayed union in 2, stiff joints in 3, and pin adjustment in 5 （including 3 malunions）. Conclusions Bone transport using a unilateral external fixator is an effective treatment procedure for posttraumatic chronic osteomyelitis. After bone transport, autologous ilium bone grafting and plate osteosynthesis is a feasible method to shorten the external fixation time and total hospital length of stay.

关 键 词：骨髓炎 创伤性 骨延长术 骨移植 

分 类 号：R687.3[医药卫生—骨科学]