骨搬运技术与骨诱导膜技术治疗感染性骨不连的疗效分析  

Bone transport technique versus induced membrane technique for treatment of infected bone nonunion

作　　者：刘亮[1] 栗树伟[1] 李岩[1] 王东[1] 

机构地区：[1]山西医科大学第二医院骨科,太原030001

出　　处：《中华创伤骨科杂志》2017年第1期81-84,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨骨搬运技术与骨诱导膜技术治疗感染性骨不连的疗效。方法回顾性分析2011年4月至2014年12月采用骨搬运技术与骨诱导膜技术治疗的46例感染性骨不连患者资料。男33例，女13例；年龄12—68岁，平均45．3岁；骨不连部位：胫骨40例，股骨6例。37例患者采用骨搬运技术，9例患者采用骨诱导膜技术。记录骨折愈合时间及并发症发生情况等，末次随访时按Johner-Wruh。评价标准评定患肢功能。结果46例患者术后获9～18个月（平均14个月）随访。骨搬运技术治疗患者骨折愈合时间平均为6．5个月（4—11个月）；无伤口感染、神经及血管损伤等并发症的发生。骨诱导膜技术治疗患者骨折愈合时间平均为5．8个月（4～11个月）；有1例患者再次感染。末次随访时按Johner-Wruhs评价标准评定患肢功能：优34例，良9例，中3例，优良率为93．5％。骨搬运技术治疗结果：胫骨骨不连优28例，良4例，中1例；股骨骨不连优1例，良2例，中1例。骨诱导膜技术治疗结果：胫骨骨不连优3例，良3例，中1例；股骨骨不连优2例。结论骨搬运技术和骨诱导膜技术治疗感染性骨不连的疗效均满意。根据骨缺损的部位及大小的不同，对于胫骨的，我们建议使用骨搬运技术；而对于股骨的，建议使用骨诱导膜技术。Objective To compare the clinical outcomes of bone transport technique versus induced membrane technique for treatment of infected bone nonunion. Methods A retrospective study was made on 46 cases of infected bone nonunion admitted from April 2011 to December 2014. They were 33 males and 13 females, aged from 12 to 68 years （mean, 45.3 years）, involving 40 tibial and 6 femoral fractures. Bone transport technique was used in 37 cases while 9 cases were treated with induced membrane technique. Fracture union and complications were recorded. The function of the affected limb was evaluated at the final follow-up using Johner-Wruhs criteria. Results The 46 cases were followed up for 9 to 18 months （mean, 14 months）. In the bone transport group, bone union was achieved after a mean duration of 6.5 months （range, from 4 to 11 months） without complications like wound infection or neurovascular lesions. In the induced membrane group, bone union was achieved after a mean duration of 5.8 months （range, from 4 to 11 months） and there was one case of re-infection. According to the Johner-Wruhs score system, 34 cases were rated as excellent, 9 as good and 3 as fair, with a total excellent and good rate of 93.5%. Bone transport technique led to 28 excellent, 4 good and one fair cases in the patients with tibial nonunion, and one excellent, 2 good and one fair cases in the patients with femoral nonunion. Induced membrane technique led to 3 excellent, 3 good and one fair cases in the patients with tibial nonunion, and 2 excellent cases in the patients with femoral nonunion. Conclusious Both bone transport technique and induced membrane technique are effective for infected bone nonunion. Bone transport technique may be preferred for tibial infected nonunion while induced membrane technique preferred for femoral infected nonunion.

关 键 词：胫骨 股骨 骨折 不愈合 骨延长 

分 类 号：R687.3[医药卫生—骨科学]