Ilizarov支架和单边支架治疗胫骨节段性骨缺损伴软组织缺损的疗效比较  

Effect comparison of Ilizarov frame and unilateral frame in the treatment of tibial segmental bone defect combined with soft tissue defect

作　　者：石博文[1] 张克刚[1] 陈旭[1] 李卫哲[1] 郭峰[1] 刘亚斌[1] 沈义东 舒衡生[1] Shi Bowen;Zhang Kegang;Chen Xu;Li Weizhe;Guo Feng;Liu Yabin;Shen Yidong;Shu Hengsheng(Department of Orthopedic Trauma,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院创伤骨科,300211

出　　处：《中华创伤杂志》2020年第2期163-171,共9页Chinese Journal of Trauma

摘　　要：目的探讨使用Ilizarov支架与单边支架进行开放骨搬移治疗胫骨节段性骨缺损伴软组织缺损的临床疗效。方法采用回顾性病例对照研究分析2008年8月—2016年8月天津医院收治并获得完整随访的32例胫骨节段性骨缺损伴软组织缺损患者临床资料,其中男22例,女10例;年龄22~64岁,平均36.7岁。19例使用Ilizarov支架(Ilizarov组),平均骨缺损长度7.9 cm,平均软组织缺损面积41.4 cm2。13例使用单边支架(单边支架组),平均骨缺损长度7.8 cm,平均软组织缺损面积39.2 cm2。比较两组骨折愈合情况、创面愈合时间、放射学骨矿化指数、外固定指数、Ilizarov技术研究与应用学会(ASAMI)骨及下肢功能评价结果及并发症发生率等。结果患者均获随访24-60个月[(32.6±1.3)个月]。骨折均获骨性愈合。Ilizarov组和单边支架组的创面愈合时间分别为(2.7±2.3)d和(2.4±1.8)d(P>0.05)。Ilizarov组骨矿化指数为(43.4±8.7)d/cm,单边支架组为(45.8±10.4)d/cm(P>0.05)。Ilizarov组和单边支架组的外固定指数分别为(52.6±8.9)d/cm和(58.7±12.9)d/cm(P<0.05)。ASAMI骨评价结果:Ilizarov组优10例,良6例,可2例,差1例,优良率84%;单边支架组优6例,良4例,可2例,差1例,优良率77%(P>0.05)。ASAMI下肢功能评价结果:Ilizarov组优8例,良7例,可3例,差1例,优良率79%;单边支架组优6,良3例,可3例,差1例,优良率69%(P>0.05)。Ilizarov组术后轴向偏移发生率为0,单边支架组为23%(P<0.05),Ilizarov组和单边支架组分别各有1例发生再骨折(P>0.05)。Ilizarov组和单边支架组分别有5例和1例发生针道感染(P>0.05)。结论采用Ilizarov支架和单边支架进行开放骨搬移治疗胫骨节段性骨缺损伴软组织缺损均可以获得较大创面与骨缺损的同时修复,但Ilizarov支架生物力学性能更优,更便于术后力线不良的纠正。Objective To compare the clinical effect of Ilizarov frame and unilateral frame in the treatment of tibial segmental bone defect combined with soft tissue defect by open bone transport.Methods A retrospective case-control study was conducted to analyze the clinical data of 32 patients with tibial segmental bone defect and soft tissue defect-up who underwent open bone transport technique in Tianjin Hospital from August 2008 to August 2016 and obtained complete followed-up.There were 22 males and 10 females,aged 22-64 years(mean,36.8 years).Nineteen patients in the Ilizarov group showed the mean bone defect length of 7.9 cm and mean soft tissue defect area of 41.4 cm2.Thirteen patients in the unilateral group showed the mean bone defect length of 7.8 cm and the mean soft tissue defect area of 39.2 cm2.The results of fracture healing,wound healing time,radiological consolidation index,external fixation index,Association for the Study and Application of the Method of Ilizarov(ASAMI)bone and lower-limb function score and incidence of complications were compared between the groups.Results All patients were followed up for 24 to 60 months[(32.6±1.3)months].Bone healing was achieved in all patients.The wound healing time was(2.7±2.3)days in Ilizarov group and(2.4±1.8)days in unilateral group(P>0.05).The consolidation index was(43.4±8.7)d/cm in Ilizarov group and(45.8±10.3)d/cm in unilateral group(P>0.05).The external fixation index was(52.6±8.9)d/cm in Ilizarov group and(58.7±12.9)d/cm in unilateral group(P<0.05).The results of ASAMI bone score was excellent in 10 patients,good in 6,fair in 2 and poor in 1 in Ilizarov group,with the excellent rate of 84%;and excellent in 6 patients,good in 4,fair in 2,and poor in 1 in unilateral group,with the excellent rate of 77%,with insignificant difference between two groups(P>0.05).The results of ASAMI lower-limb function score was excellent in 8 patients,good in 7,fair in 3,poor in 1 in Ilizarov group,with the excellent rate of 79%;and excellent in 6,good in 3,fair in 3,poo

关 键 词：胫骨骨折 感染 伊利扎罗夫技术 软组织损伤 

分 类 号：R687.3[医药卫生—骨科学]