骨延长术治疗下肢骨髓炎性骨缺损的临床研究  

Clinical study of bone lengthening in treatment of osteomyelitis bone defect of lower limbs

作　　者：杨军[1] 许建中[2] 黄宗强[2] 蔡喜雨 YANG Jun;XU Jianzhong;HUANG Zongqiang;CAI Xiyu(Department of Orthopaedics,Affiliated Hospital of Xinyang Vocational and Technical College,Xinyang 464000,Henan;Department of Orthopaedics,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450003;Department of Orthopaedics,Fifth Affiliated Hospital of Sun Yat-Sen University,Zhuhai 528400,Guangdong,China)

机构地区：[1]信阳职业技术学院附属医院骨科,河南信阳464000 [2]郑州大学第一附属医院骨科,郑州450003 [3]中山大学附属第五医院骨科,广州珠海528400

出　　处：《中华骨与关节外科杂志》2020年第9期752-756,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:下肢骨髓炎性骨缺损的修复方法很多,其中骨延长术是一种通过骨骼牵引矫正肢体长度不均衡而被广泛应用于创伤及骨感染、肿瘤、先天性畸形等疾病的综合性技术。目的:探讨骨延长术治疗下肢慢性骨髓炎性骨缺损的术后缺损部位延长效果以及并发症情况。方法:回顾性分析2016年3月至2018年4月采用骨延长术治疗的32例下肢骨髓炎性骨缺损患者,男20例,女12例;年龄22~52岁,平均(37.9±11.3)岁。患者均为下肢骨折术后并发慢性骨髓炎、骨不连,入院前有2~4次手术史,病程12~36个月,平均(24.9±8.5)个月。骨髓炎部位为股骨22例,胫骨10例;缺损大小为2~4 cm,平均(3.2±0.6)cm。清创术后同期行骨延长术治疗,术后定期进行X线检查,随访观察缺损部位的成骨情况,末次随访时采用Paley评分对骨不连愈合情况进行疗效评估。结果:全部获得随访,随访时间为16~28个月,平均(22.6±6.4)个月。本组患者中,治疗效果获优26例,良6例。32例患者骨延长区骨再生情况均良好,患肢骨延长长度为6~10 cm,平均(7.9±1.4)cm,外固定架佩戴时间为5~11个月,平均(8.2±2.8)个月。骨延长术治疗期间,除发生针道感染、术区疼痛外,无软组织感染、血管以及神经损伤等并发症的发生。结论:清创后行骨延长术可重建下肢骨髓炎性骨缺损部位的长度,患者下肢骨和关节功能恢复良好,是治疗下肢骨髓炎性骨缺损的一种有效方法。Background:There are many methods for repairing osteomyelitis bone defects in the lower extremities.Among them,bone lengthening is a comprehensive technique that is used to correct the imbalance of limb length through bone traction and is widely used in trauma and bone infections,tumors,congenital deformities and other diseases.Objective:To explore the effect of bone lengthening to treat chronic osteomyelitis bone defects in the aspect of postoperative defect extension and complications.Methods:From March 2016 to April 2018,32 patients with osteomyelitis bone defects in the lower extremities were treated with bone lengthening including 20 males and 12 females with the mean age of(37.9±11.3)years(range,22-52 year).All patients had chronic osteomyelitis and nonunion after the fracture of the lower extremity.The course of disease was 12 to 36 months,with an average of(24.9±8.5)months.They all had operation history with 2-4 surgeries.22 patients had osteomyelitis at femur and 10 patients at tibia.The length of bone defect was(3.2±0.6)cm on average with the range of 2-4 cm.The bone lengthening was taken after debridement simultaneously.X-ray examination was used to observe the osteogenesis of the defect site at the follow-up.Paley scale was used at the last follow-up to evaluate the effect of nonunion healing.Results:All patients were followed up for 16-28 months with the mean of(22.6±6.4)months.26 patients had excellent outcomes and 6 patients had good outcomes.32 patients had good bone regeneration in the bone extension area with the mean extension length of(7.9±1.4)cm(range,6-10 cm).The patients wore external fixators for 5-11 months,with an average of(8.2±2.8)months.No complications such as soft tissue infection,blood vessel and nerve injury were found,except for needle tract infection and pain in the operation area during the treatment of bone lengthening period.Conclusions:Bone lengthening after debridement can reconstruct the length of osteomyelitis bone defect of the lower extremity with good bone and jo

关 键 词：股骨骨折 胫骨骨折 骨髓炎 骨不连 感染 清创 骨延长术 

分 类 号：R687.3[医药卫生—骨科学]