Ilizarov外固定“手风琴技术”治疗成人股骨骨不连  

Ilizarov frame fixation “accordion technique” for adult aseptic femoral nonunion

作　　者：郭保逢[1] 赵巍[1] 徐执扬[1] 吴鸿飞[1] 陈蕾 秦泗河 GUO Bao-feng;ZHAO Wei;XU Zhi-yang;WU Hong-fei;CHEN Lei;QIN Si-he(Department of Orthopaedics,Beijing Chui Yang Liu Hospital,Beijing,100022,China;Department of Orthopaedics,Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids,Beijing,100072,China)

机构地区：[1]北京市垂杨柳医院矫形骨科,北京100020 [2]国家康复辅具研究中心附属康复医院矫形骨科,北京100170

出　　处：《中国矫形外科杂志》2020年第3期267-270,共4页Orthopedic Journal of China

摘　　要：[目的]探讨Ilizarov外固定"手风琴技术"治疗成人股骨无菌性骨不连的临床疗效。[方法]2012年7月~2017年1月,采用Ilizarov环形外固定缓慢牵伸-加压的"手风琴技术"治疗成人股骨无菌性骨不连11例。其中男7例,女4例,年龄24~47岁,平均(37.10±7.60)岁。患肢短缩>2.5 cm者术中结合股骨近端闭合截骨加装骨延长组件,备术后肢体延长。采用Paley骨不连评价标准进行评价。[结果]11例患者获得随访,随访时间24~49个月,平均(27.47±6.70)个月。所有骨不连均临床骨性愈合,愈合时间6.00~24.70个月,平均(10.20±9.42)个月。采用Paley骨不连评价标准,优5例、良5例、可1例,优良率90.91%(10/11)。末次随访>7°局部畸形2例(7°、10°矢状位畸形),不影响功能,未作特殊处理。1例术后肢体短缩3.1cm。针道感染发生率72.73%(8/11),通过换药及更换固定针等控制,10°以上膝关节活动丢失3例,未发生再骨折、深部感染和血管神经损伤等并发症。[结论]Ilizarov外固定"手风琴技术"依据张力-应力法则,避免了植骨,规律牵伸-再加压治疗成人股骨无菌性骨不连疗效可靠。[Objective]To evaluate the outcomes of patients with femoral shaft nonunion treated by Ilizarov frame fixation"accordion technique".[Methods]We studied 11 consecutive patients with adult femoral nonunion:7 male and 4 female with an average age of(37.10±7.60)years(range,24~47 years).Closed subtrochanteric osteotomy and bone lengthening module were required in the patients with limb shortening>2.5 cm.All patients were evaluated by Paley nonunion evaluation criteria.[Results]All 11 patients were followed up.The mean postoperative follow-up was(27.47±6.70)months(range,24~49 months).Bony union was achieved in all 11 cases after a mean of(10.20±9.42)months(range,6.00~24.70 months).According to Paley nonunion healing score,5 cases were excellent,5 were good and 1 were fair,yielding an excellent to good rate of 90.91%(10/11).There were 2 local femoral shaft malformations beyond 7°(7°and 10°sagittal malformation),1 case with limb shortening by 3.1 cm,8 superficial pin tract infections and 3 cases with Loss of knee motion above 10°.No complications such as deep infection and vascular nerve injury occurred.[Conclusion]Ilizarov circular frame fixation"accordion technique",based on the principle of"law of tension-stress"in the way of cyclic compression and distraction without bone graft is a reliable method for the treatment of aseptic femoral shaft nonunion.

关 键 词：Ilizarov方法 手风琴技术 股骨干骨折 无菌性骨不连 

分 类 号：R687[医药卫生—骨科学]