显微外科技术结合Ilizarov外固定架治疗胫骨外露合并骨缺损的效果研究  

Microsurgical Technique Combined with Ilizarov External Fixator in the Treatment of Open Tibial Fracture with Bone Loss

作　　者：杨亚东[1] 周娟[2] 唐文[1] 赖光松[1] 张飞[1] 刘氜[1] 魏晓军[1] 

机构地区：[1]赣南医学院第一附属医院骨科,江西省赣州市341000 [2]赣南医学院生物化学与分子生物学教研室,江西省赣州市341000

出　　处：《中国全科医学》2018年第2期239-243,共5页Chinese General Practice

摘　　要：目的探讨应用显微外科技术结合Ilizarov外固定架治疗胫骨外露合并骨缺损的临床效果。方法选取2011年7月—2016年4月于赣南医学院第一附属医院治疗的胫骨骨折合并骨外露及骨缺损患者50例为研究对象。患者进行彻底清创后,用显微外科技术将游离皮瓣覆盖胫骨外露骨质,再行Ilizarov外固定架骨迁移治疗骨不连。结果患者手术时间80~120 min,平均(85.0±4.4)min;骨迁移长度5~11 cm,平均(6.0±4.6)cm;Ilizarov外固定架固定时间13~22个月,平均(15±3)个月;牵移骨痂矿化时间13~23周,平均(14.0±3.6)周。患者均获得随访,随访时间12~28个月,平均(16.2±5.5)个月。2例出现远端骨不连,给予髂骨植骨达到愈合。2例出现马蹄足畸形,给予行外固定架矫形。术中、术后无神经血管损伤表现,无再次骨折发生。根据Johner-Wruh评定疗效,优35例,良12例,差3例,优良率94%。结论胫骨骨折合并骨外露、骨缺损患者应用显微外科技术结合Ilizarov外固定技术,可降低患者截肢率,促进骨折的愈合,缩短治疗时间,临床总体疗效较好。Objective To investigate the clinical effect of microsurgical technique combined with Ilizarov external fixator in the treatment of open tibial fracture with bone loss.Methods Fifty cases of open tibial fracture with bone loss treated in the First Affiliated Hospital of Gannan Medical University from July 2011 to April 2016 were selected as the subjects.After complete debridement,the exposed tibial bone was covered by the free skin flap with the microsurgical technique,and bone nonunion was treated by bone transfer with Ilizarov external fixator.Results The duration of surgery ranged from 80 min to 120 min,with an average of（85.0±4.4） min;the length of bone transfer was 5-11 cm,averaged（6.0±4.6） cm;the duration for treatment with Ilizarov external fixator was 13-22 months,averaged（15±3） months;the time required for callus mineralization was 13-23 weeks,averaged（14.0±3.6） weeks;the follow-up period for all patients was 12-28 months,with an average of（16.2±5.5） months.Two cases had distal bone nonunion,but were healed by iliac bone grafting;2 had equinus deformity,and they were treated by correction with external fixator.There were no neurovascular injuries and re-fracture occurred during or after surgery.Based on the assessment by Johner-Wruhs＇ criteria,the curative effect was excellent in 35 cases,good in 12 cases and poor in 3 cases,with an excellent and good rate of 94%.Conclusion For patients with open tibial fracture and bone loss,using the microsurgical technique with Ilizarov external fixation can achieve good overall clinical efficacy with specific manifestations of reduced amputation rate,promoted fracture healing,and shortened treatment duration.

关 键 词：胫骨骨折 显微外科手术 外固定器 

分 类 号：R683.42[医药卫生—骨科学]