清创后同期骨延长术治疗胫骨骨折患者骨不连的临床疗效  

Effect evaluation of debridement and bone elongation for nonunion after tibial fractures

作　　者：闫厚军[1] 马志国[1] 郭永军[1] 马斌[1] 付贯忠[1] 侯小冬[1] 李启明[1] 杨永焱[1] 付鲲鹏[1] YAN Hou-jun;MA Zhi-guo;GUO Yong-jun;MA Bin;FU Guan-zhong;HOU Xiao-dong;LI Qi-ming;YANG Yong-yan;FU Kun-peng(Department of Orthopedic Trauma, the 252nd Hospital of Chinese PLA, Baoding, Hebei, 071000, China)

机构地区：[1]保定解放军第252医院创伤骨科,河北071000

出　　处：《中国骨与关节杂志》2017年第12期943-946,共4页Chinese Journal of Bone and Joint

摘　　要：目的探究应用清创后同期骨延长术治疗胫骨骨折患者骨不连的临床效果。方法选取2013年1月至2015年12月我院收治的31例胫骨骨折后发生感染性骨不连的患者,其中29例有活动性感染征象,25例创口有内固定物,本组均采用清创后同期外固定支架骨延长术治疗,根据骨愈合情况和关节功能情况评价疗效。结果本组治疗效果优25例,良5例,可1例,总体优良率96.8%;随访12个月,骨不连接处已全部愈合,骨延长区生长满意,延长后双侧下肢长度差评价(1.2±0.5)cm,平均骨延长长度(7.6±1.2)cm;并发症统计显示,本组均出现不同程度的疼痛,3例疼痛剧烈无法忍受,给予止痛药后缓解,17例出现针道感染,5例因骨质疏松导致固定针滑脱,再次行手术后未出现滑脱,2例行跟腱延长手术。结论清创同期行外固定支架骨延长术治疗胫骨骨折后骨不连的疗效确切,手术效果满意,患者骨愈合及关节功能恢复良好,值得在临床上推广和应用。Objective To explore the clinical effects of debridement and bone elongation at the same period in the treatment of nonunion after tibial fractures. Methods Thirty-one patients with infectious nonunion after tibial fractures treated from Jan. 2013 to Dec. 2015 were chosen as the research subjects. Among them, 29 patients had signs of active infections, and 25 patients had wounds with internal fixation. All patients were treated by bone extension surgery with external fixation after the same period of debridement. Clinical effects were evaluated according to the bone healing and joint function. Results Treatment effects were excellent in 25 cases, good in 5 cases and fair in 1 case. The overall excellent and good rate was 96.8%. All patients were followed up for at least 12 months. All the nonunion had healed, with satisfactory bone extension. The length difference of extended bilateral lower limbs was （ 1.2 ＆#177; 0.5 ） cm. The average length of bone extension was （ 7.6 ＆#177; 1.2 ） cm. The statistics for complications showed that this group of patients had various degrees of pain. Three patients had severe and intolerable pain, who got relieved after given pain relief. Seventeen patients had needle infection. Five patients had fixed needle slippage due to the osteoporosis, and slippage did not appear again after the surgery. Two patients received Achilles tendon surgery. Conclusions Clinical effects of debridement and bone elongation with external fixation at the same period are definite in the treatment of nonunion after tibial fractures. Results are satisfactory, with good bone healing and joint function recovery. It is worthy to be popularized and applied in clinic.

关 键 词：胫骨骨折 骨不连 感染 清创 骨延长术 

分 类 号：R683.4[医药卫生—骨科学] R687.3[医药卫生—外科学]