单边外固定骨搬运技术治疗肱骨大段骨缺损  

Treatment of large segmental humeral defects with unilateral external fixation and bone transport

作　　者：肖庭辉 林依淼 任晋可 贾兆锋 王华[1] 李广恒 张晓明 Xiao Tinghui;Lin Yimiao;Ren Jinke;Jia Zhaofeng;Wang Hua;Li Guangheng;Zhang Xiaoming(Department of Orthopedics,Shenzhen People's Hospital,Shenzhen 518020,China)

机构地区：[1]深圳市人民医院骨关节科,518020

出　　处：《中华创伤骨科杂志》2020年第11期997-1000,共4页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金青年项目(81902196)。

摘　　要：目的探讨使用单边外固定支架行骨搬运技术治疗肱骨大段骨缺损的临床疗效。方法回顾性分析2017年9月至2019年6月深圳市人民医院骨关节科治疗的9例肱骨大段骨缺损患者资料。男5例,女4例;年龄21~41岁,平均29岁。缺损原因:外伤导致缺损2例,慢性骨髓炎6例,骨肿瘤1例。骨缺损长度4.2~9.0 cm,平均5.9 cm。手术安置单边外固定支架,术后7~10 d定期调整外固定支架行骨搬运,逐步恢复肱骨长度,复查X线片见有3~4层皮质后,可拆除外固定支架。记录肱骨延长长度、延长率、骨折愈合时间、外固定支架携带时间及并发症情况,同时记录并比较术前与术后15个月上肢功能评分(DASH)。结果所有患者术后获15~36个月(平均19个月)随访。延长长度平均5.9 cm,延长率平均26%,平均愈合指数为31 d/cm。骨愈合时间平均8.3个月,外固定支架携带时间平均10.8个月。DASH评分从术前的(25.0±2.4)分改善至术后15个月的(12.0±1.8)分,差异有统计学意义(P<0.05)。所有患者肱骨大段骨缺损均得到良好的矫治,除1例暂时性的桡神经麻痹外,其他均无血管、神经损伤等并发症,肩肘关节功能基本正常。结论采用单边外固定支架行骨搬运治疗肱骨大段骨缺损可较快治疗缺损,恢复患者的上肢功能。Objective To investigate the clinical treatment of large segmental humeral defects with unilateral external fixation and bone transport.Methods A retrospective study was conducted of the 9 patients who had been treated at Department of Orthopedics,Shenzhen People's Hospital for large segmental humeral defects from September 2017 to June 2019.They were 5 males and 4 females with an average age of 29 years(from 21 to 41 years).Their defects were caused by trauma in 2 cases,by chronic osteomyelitis in 6 cases and by bone tumor in one case.The length of bone defect ranged from 4.2 to 9.0 cm,with an average of 5.9 cm.A unilateral external fixator was placed in operation,and adjusted regularly 7 to 10 days after operation for bone transport and bone lengthening to restore the length of humerus gradually.The external fixation bracket was removed after 3 to 4 layers of cortex were observed on X-ray films.Recorded were length and rate of humeral lengthening,fracture healing time,time for carrying external fixator and complications;the Disabilities of the Arm,Shoulder and Hand(DASH)scores were compared between preoperation and 15 months postoperation.Results All the patients were followed up for 15 to 36 months(mean,19 months).The length of lengthening averaged 5.9 cm(from 4.2 to 9.0 cm)with an average lengthening rate of 26%,the healing index 31 d/cm,the bone healing time 8.3 months,and the time for carrying external fixator 10.8 months(from 8.0 to 13.5 months).Their average DASH scores improved significantly from 25.0±2.4 preoperation to 12.0±1.8 at 15 months postoperation(P<0.05).Good correction of large humeral defects was achieved in all but one case who reported temporary radial nerve paralysis.There were no such complications as neurovascular injury.The shoulder and elbow functions were basically normal after operation.Conclusions In the treatment of large segmental humeral defects,unilateral external fixation plus bone transport can quickly repair the defects and recover the upper limb function of the patients.

关 键 词：肱骨 骨延长术 外固定器 大段缺损 ILIZAROV技术 

分 类 号：R687.3[医药卫生—骨科学]