锁定加压钢板外固定结合自体髂骨植骨治疗胫骨骨搬运后搬移间隙骨折  

Treatment of tibial transport gap fracture after bone transport by external fixation with locking compression plate and autologous iliac grafting

作　　者：刘亦杨[1] 沈立锋[1] 张春[1] 郭峭峰[1] 林炳远[1] 黄凯[1] 鲁宁[1] 马苟平[1] 翟立锋 张展[1] 

机构地区：[1]浙江省立同德医院骨科,杭州310012

出　　处：《中华创伤骨科杂志》2017年第12期1088-1092,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用锁定加压钢板（LCP）外固定结合自体髂骨植骨治疗胫骨骨搬运后搬移间隙骨折的临床疗效。方法回顾性分析2015年2月至2016年1月应用LCP外固定结合自体髂骨植骨治疗的9例胫骨骨搬运后搬移间隙骨折患者资料。男7例，女2例；平均年龄40．2岁（26～56岁）。1例患者因断肢再植后肢体短缩行肢体延长，其余均为创伤性骨髓炎行骨搬运。胫骨骨搬运距离平均9．2cm（7～12cm），外固定支架带架时间平均20．1个月（13～25个月），拆除外固定支架至发生骨折平均1．8周（1～3周），其中2例合并对合端愈合后再骨折。骨折至手术时间为4．1d（3～5d）。5例患者骨折后出现不同程度成角畸形，术中无法完全纠正。根据骨折临床愈合标准评定疗效。结果9例患者术后获11～15个月（平均13．1个月）随访。LCP外固定时间平均9．0个月（8～10个月），骨折愈合时间平均4．6个月（4～5个月）。5例成角畸形患者骨折畸形愈合，但肢体外观无明显畸形。1例患者出现小腿广泛蜂窝织炎，予静脉应用抗生素后痊愈，均未出现钉道感染。拆除LCP外固定时膝关节及踝关节功能较骨搬运后拆除外固定支架时均无明显改变。髂骨供区及骨折植骨处手术切口均甲级愈合。结论LCP外固定结合自体髂骨植骨是治疗胫骨骨搬运术后搬移间隙骨折的有效方法，固定可靠，软组织损伤小，疗效确切，且外观小巧，但操作技术及术后护理等方面要求较高。Objective To explore the curative efficacy of treating tibial transport gap fracture after bone transport by external fixation with locking compression plate（LCP） and autologous lilac grafting. Methods From February 2015 to January 2016, 9 patients who had sustained tibial transport gap fracture after bone transport were treated by LCP external fixation and autologous iliae grafting. They were 7 men and 2 women, aged from 26 to 56 years （average, 40. 2 years） . One of them received bone transport because of limb shortness after replantation and others did because of traumatic osteomyelitis. The distances of tibial transport averaged 9.2 cm （from 7 to 12 cm）; the time for external fixation averaged 20. 1 months （from 13 to 25 months）; the time from removal of external fixator to gap fracture averaged 1.8 weeks （from 1 to 3 weeks）. Two patients were complicated with docking site fracture. The durations from gap fracture to operation averaged 4. 1 days （from 3 to 5 days） . Five patients sustained angular deformity of various severities which could not be corrected by surgery. The curative efficacy was evaluated according to conventional criteria for fracture healing. Results The 9 patients were followed up for 11 to 15 months （average, 13. 1months）. The time for LCP external fixation averaged 9.0 months （from 8 to 10 months）; the time for fracture union averaged 4.6 months （from 4 to 5 months）. The 5 patients with angular deformity obtained fracture malunion which did not obviously affect their limb ap- pearance. One case suffered extensive cellulitis at the leg which responded to intravenous administration of antibiotics. No pin track infection happened. The knee and ankle functions after removal of LCP external fixation were not significantly different from those after removal of external fixator following bone transport. Wounds at the iliac donor site and bone graft area all healed well. Conclusions LCP external fixation is an effective treatment for tibial transport gap fractu

关 键 词：胫骨 骨板 外固定器 植骨 骨搬运 

分 类 号：R687.3[医药卫生—骨科学]