外固定支架治疗感染性骨折不愈合  

Treatment of infected nonunion by external fixation

作　　者：王善玺 李沁[2] 李博华 张正东 王光林[1] 刘雷[1] Wang Shanxi;Li Qin;Li Bohua;Zhang Zhengdong;Wang Guanglin;Liu Lei(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,China（Wang SX,Li BH,Zhang ZD,Wang GL,Liu L;Department of Orthopaedics,Tibetan Chengdu Office Branch Hospital of West China Hospital,Sichuan University,Chengdu 610041,China（Li Q)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]四川大学华西医院西藏成办分院骨科,成都610041

出　　处：《中华创伤骨科杂志》2018年第10期849-854,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用外固定支架治疗感染性骨折不愈合的临床疗效。方法回顾性分析2009年6月至2016年12月四川大学华西医院骨科采用外固定支架治疗的45例感染性骨折不愈合患者资料，男36例，女9例；年龄14～65岁，平均45．3岁；部位：胫骨31例，股骨12例，肱骨1例，尺桡骨1例。患者自受伤至到我院应用外固定支架治疗时间平均16．8个月，入院前手术次数平均2．3次，24例患者病灶清除后存在3．5～10．4cm（平均6．0cm）的骨缺损。术后定期门诊复查，记录并发症的发生情况，末次随访时根据ASAMI评估标准分别评估骨及功能结果。结果所有患者均获随访，时间16～106个月（平均43．9个月），1例患者因治疗失败行截肢术，其余44例患者均实现骨性愈合，24例骨缺损患者均通过骨搬运成功修复骨缺损，带架时间6．60个月（平均20．5个月）。末次随访时根据ASAMI评估标准，骨结果：优28例，良12例，中1例，差3例，优良率90．9％；功能结果：优11例，良21例，中8例，差4例，优良率72．7％。结论应用外固定支架不仅能够避免内固定感染等风险，而且能够矫正复杂畸形及修复大段骨缺损，同时允许患者早期下床负重，有效地根除感染和治疗骨折不愈合。Objective To explore the curative effects of external fixation in the treatment of infected nonunion. Methods From June 2009 to December 2016, 45 patients with infected nonunion were treated by external fixation at Department of Orthopaedics, West China Hospital. They were 36 males and 9 females with an average age of 45.3 years （range, from 14 to 65 years） . The sites of fracture included tibia in 31 patients, femur in 12, humerus in one, and ulna-radius in one. The median time from injury to application of external fixation was 16.8 months and the average number of previous operations was 2.3 times. After de- bridement, 24 cases had a bone defect of 6.0 cm in length on average （range, from 3.5 to 10. 4 era）. After discharge, the patients were regularly followed up at the outpatient department and any of their complications was recorded in detail. At the final follow-ups, the protocol of ASAMI （Association for the Study and Appli- cation of the Method of Ilizarov） was used to evaluate their bone and functional results. Results All the 45 patients were followed up for 16 to 106 months （average, 43.9 months）. One patient had to receive am- putation because of uncontrollable infection and all the other 44 cases achieved bony union. The bone defects were successfully reconstructed by external bone transport in 24 patients. The time for external fixation aver- aged 20.5 months. According to the evaluation by ASAMI at the final follow-ups, the bone was rated as ex- cellent in 28 patients, as good in 12, as fair in one and as poor in 3, giving an excellent to good rate of 90. 9% ; the function was rated as excellent in 11 patients, as good in 21, as fair in 8 and as poor in 4, giving an excellent to good rate of 72.7%. Conclusion In eradication of infection and treatment of fracture nonunion, external fixation can be used not only to avoid the infection risk due to internal fixation but also to correct a complex deformity and repair a large bone defect, allowing early weight-bearing for the patients.

关 键 词：骨折 不愈合 感染 外固定器 骨搬运术 

分 类 号：R687.3[医药卫生—骨科学]