Ilizarov骨搬移技术治疗胫骨大段骨缺损并发症的分析  

Analysis of complications using the Ilizarov technique for treatment of large tibia bone defect

作　　者：扈克治[1] 甘干达[1] 程洪 韩健[1] 罗平[1] 黄育胡[1] 李松涛 HU Kezhi, GAN Ganda, CHENG Hong, et al(Department of Orthopedic, The 181th Hospital of PLA, Guilin, Guangxi, 541002, Chin)

机构地区：[1]中国人民解放军第181医院创伤骨科,广西桂林541002

出　　处：《实用手外科杂志》2017年第4期403-406,共4页Journal of Practical Hand Surgery

基　　金：全军医学科技青年培育项目基金（编号：14QNP046）

摘　　要：目的 探讨Ilizarov骨搬移技术在治疗胫骨大段骨缺损过程中出现并发症的原因并总结防治经验.方法 对2013年5月-2016年12月采用Ilizarov骨搬移技术治疗并获随访的37例胫骨大段骨缺损病例术后出现并发症的原因、类型、严重程度及处理方法和效果进行回顾性分析总结.结果 随访4~26个月（平均18个月）,37例中出现并发症19例26次,其中针道感染5次,关节活动受限7次,皮肤热灼伤1次,矿化不良或骨延迟愈合4次,轴向偏移2次,关节脱位1次,断针1次,继发关节畸形2次,严重骨质疏松2次,外固定器拆除后再骨折1次.采用换药、功能锻炼及二次手术等方法处理,最终有2例遗留功能障碍.结论 在应用Ilizarov骨搬移技术治疗胫骨大段骨缺损过程中,手术各环节均有并发症出现可能.操作医生应充分理解技术原理,严格掌握手术适应证及操作标准,按时随访（指导功能锻炼、动态调节搬移速度等）,方能有效降低并发症的发生率.Objective To analyze the causes of the complications in the treatment of large tibia bone defect with the Ilizarov technique and to summarize the experience againt these complications. Methods From May 2013 to December 2016, 37 patients with tibia bone defect who had been treated with Ilizarov technique （bone transport） were retrospectively analyzed. Statistical analysis was used to compare the type, severity, treatment methods and results of complications. Results Postoperative follow-up lasted for 4 to 26 months, with an average of 18 months. There were 5 cases of pin tract infections, 7 cases of restricted joint movements, 1 case of skin thermal damage, 4 cases of bone delayed union, 1 case of dislocation, 1 case of fixed needle breakage, 2 cases of secondary joint deformities, 2 cases of serious osteopomsis, 1 case of subsequent fracture after external fixator was dismantled. Combining with dressing change, functional training and the second-stage operation therapy and so on, a permanent disability was finally left in 2 patients.Conclusion If the Ilizarov technique is used improperly, there will be multiple complications during the preoperative preparation, surgical procedures and postoperative management. To reduce the rate of complications, effective preventive measures should be taken, such as following the principle of the Ilizarov technique, standardizing operation procedures, correcting postoperative rehabilitation exercise guidance, regular follow-up of radiography and postoperative adaptability to dynamic adjustment of the external technique.

关 键 词：ILIZAROV技术 骨搬移 骨缺损 并发症 

分 类 号：R687.3[医药卫生—骨科学]