骨搬运治疗胫骨骨缺损合并软组织缺损的疗效及影响因素  

Effect of bone transport on tibial bone defect and parenchyma defect and its influencing factors

作　　者：谢伟文[1] 谌业光[1] 张伟才 XIE Wei-wen;CHEN Ye-guang;ZHANG Wei-cai(Department of Trauma and Orthopaedic Surgery,Meizhou People s Hospital,Meizhou Guangdong 514031,China)

机构地区：[1]梅州市人民医院创伤骨外科,广东梅州514031

出　　处：《局解手术学杂志》2018年第9期650-654,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨骨搬运治疗胫骨骨缺损合并软组织缺损的疗效及发生并发症的影响因素。方法回顾性分析我院2014年3月至2017年5月30例骨搬运治疗胫骨骨缺损合并软组织缺损患者的临床资料,其中20例为创伤性慢性骨髓炎致下肢长骨骨缺损患者,10例为创伤后非感染性下肢长骨骨缺损患者。观察所有患者的治疗效果及并发症发生情况,并分析疗效及安全性的影响因素。结果 30例患者均获得随访,随访时间大于8个月,平均16. 9个月。治疗周期为8~15个月,平均12. 3个月。术后骨搬运完成,外固定架使用时间为术后220 d,皮肤均在骨搬运过程中自然愈合,术后均给予功能锻炼,6个月后愈合。在治疗过程中,出现骨不愈合18例,软组织嵌顿12例,接触面积不足6例,对线不良8例。单因素分析结果显示,软组织调节差是骨搬运治疗过程中断端软组织嵌顿的影响因素,感染是断端骨不愈合的影响因素,股骨骨缺损是骨搬运过程中断端对线不良的影响因素。结论胫骨骨缺损合并软组织缺损应用骨搬运技术后软组织嵌顿、断端骨不愈合、对线不良等并发症发生率较高,虽然最终均可通过后期的治疗达到愈合,但是影响康复时间,在治疗过程中软组织修复差、感染、股骨骨缺损等均应引起骨科医生的重视。Objective To investigate the effect of bone transport on tibial bone defect and parenchyma defect and the influencing factors of complication.Methods The clinical data of 30 cases with tibial bone defect combined with parenchyma defect in our hospital from March 2014 to May 2017 treated by bone handling were retrospectively analyzed.Among the pateints,20 cases were caused by traumatic chronic osteomyelitis and 10 cases were non-infectious bone defects of lower extremity after trauma.The therapeutic effect and complications were recorded,and the factors influencing the efficacy and safety were analyzed. Results In this study,30 patients were followed up for more than 8 months,with an average follow-up time of 16.9 months.The treatment period was 8~ 15 months,and the average treatment period was 12.3 months.After operation,the bone handling was completed,the external fixator was used for 220 days,the skin healed naturally in the process of bone handling,all the skin were given functional exercise after operation,and healed half a year later.In the course of treatment,there were 18 cases of bone nonunion,12 cases of soft tissue incarceration,6 cases of insufficient contact area and 8 cases of poor alignment.Univariate analysis showed that poor soft tissue regulation was the influencing factor of soft tissue incarceration at the interrupted end of bone handling treatment,infection was the influencing factor of broken end bone nonunion,and femoral bone defect was the influence factor of broken end misalignment of bone transport.Conclusion The incidence of complications such as soft tissue incarceration,nonunion of broken bone and poor alignment was higher in patients with tibial bone defect combined with parenchyma defect.Although the healing time could be achieved through the treatment of later stage,the recovery time was affected.In the course of treatment,poor parenchyma repair,infection and femoral bone defect should be paid more attention by orthopedic doctors.

关 键 词：骨搬运 胫骨 骨缺损 软组织 

分 类 号：R683.42[医药卫生—骨科学]