Ilizarov技术近弧形骨块滑移同期治疗创伤性跟骨骨髓炎并缺损畸形  

Simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique

作　　者：张磊 陈雨声 王新卫 化昊天 绳景亚 陈江非 郭再冉 ZHANG Lei;CHEN Yusheng;WANG Xinwei;HUA Haotian;SHENG Jingya;CHEN Jiangfei;GUO Zairan(No.l Department of Osteomyelitis,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang Henan,471002,P.R.China;Department of VIP,the Second Affiliated Hospital of Henan University of Science and Technology,Luoyang Henan,471000,P.R.China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)骨髓炎一科,河南洛阳471002 [2]河南科技大学第二附属医院VIP科,河南洛阳471000

出　　处：《中国修复重建外科杂志》2021年第3期323-329,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河南省科技厅课题(182102310487)。

摘　　要：目的探讨应用Ilizarov技术近弧形骨块滑移同期治疗创伤性跟骨骨髓炎并缺损畸形的临床疗效。方法2014年1月—2020年8月,结合Ilizarov技术使骨块近弧形滑移同期治疗创伤性跟骨骨髓炎并缺损畸形6例。患者均为男性;年龄40~61岁,平均49.3岁。病程2~72个月,平均16.1个月。均为外伤导致跟骨骨髓炎,其中高处坠落伤4例、交通事故伤1例、砸伤1例。感染波及距跟关节4例,距跟关节已融合或部分融合2例。拆除外固定架后采用Maryland足部评分系统评价足部功能,美国矫形足踝协会(AOFAS)踝-后足功能评分系统评价踝-后足功能,并与术前评分比较。结果术后患者均获随访,随访时间1.5~26.0个月,平均16.3个月。患者术后切口均Ⅰ期愈合,无感染复发,均未行二期植骨融合等手术。跟骨骨髓炎伴缺损畸形一期截骨滑移5例,跟骨骨折感染清创术后原骨块病灶清除后直接滑移1例;骨块滑移时间28~62 d,平均38.7 d;滑移距离3.1~5.2 cm,平均3.6 cm。1例患者因术后时间较短,跟骨滑移部骨质尚未愈合,未拆除外固定架(未参与临床评分),但足部外形、复查X线片及带架行走等情况满意。其余5例带架时间为6~8个月,平均6.5个月。拆除外固定架后可见足部恢复三点着力负重,纵弓可见不同程度恢复,未出现明显内外翻。Maryland评分为(80.8±4.7)分,较术前(33.6±4.3)分显著改善(t=-35.782,P=0.000),获优3例、良2例;AOFAS踝-后足评分中位数为84分,四分位数间距为(79,86)分,较术前评分[中位数为33.5分,四分位数间距为(21.3,37.5)分]显著改善(Z=-2.023,P=0.043),获优4例、良1例。其中疼痛、步行距离、摆脱助行工具、上下楼梯、畸形等方面较术前明显改善,距下、足跗关节活动度较差或消失。结论应用Ilizarov技术近弧形骨块滑移同期治疗创伤性跟骨骨髓炎并缺损畸形可以优化手术方式,减少手术次数,尽量模拟跟骨原形态重建,是一种有�Objective To investigate the effectiveness of simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique.Methods Between January 2014 and August 2020,6 cases of traumatic calcaneal osteomyelitis with defect deformities were treated by simultaneous treatment of near-arc bone transport by Ilizarov technique.The patients were all male;aged from 40 to 61 years(mean,49.3 years).The disease duration was 2-72 months,with an average of 16.1 months.All patients were traumatic calcaneal osteomyelitis,including 4 cases of falling from height,1 case of traffic accident injury,and 1 case of crushing injury.The infection affected the talar-heel joint in 4 cases,and the talar-heel joint was fused or partially fused in 2 cases.After the external fixator was removed,the Maryland foot scoring system was used to evaluate the foot function,and the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scoring system was used to evaluate the ankle-hindfoot function,and were compared with the preoperative scores.Results All patients were followed up 1.5-26.0 months,with an average of 16.3 months.All incisions healed by first intention,no recurrence of infection occurred,and no surgical intervention such as second-stage bone grafting and fusion was performed.Five cases of calcaneal osteomyelitis with defect deformity underwent one-stage osteotomy and slipped,1 case of the original bone mass after debridement after infection of calcaneal fractures slipped directly.The bone sliding time was 28-62 days,with an average of 38.7 days;the sliding distance was 3.1-5.2 cm,with an average of 3.6 cm.In 1 patient,due to the short follow-up time,the calcaneal slip bone had not healed,the external fixator had not been removed(not involved in clinical scoring),but the foot shape,reexamination of X-ray films and with frame walking were satisfactory.The time with external fixator was 6-8 months,with an average of 6.5 months in the other 5 cases.After removing the

关 键 词：跟骨骨髓炎 创伤 骨缺损畸形 ILIZAROV技术 

分 类 号：R687.3[医药卫生—骨科学]