Ilizarov技术结合载万古霉素骨水泥治疗胫骨创伤后骨感染合并骨与软组织缺损的疗效  

Ilizarov technique combined with vancomycin bone cement for treatment of posttraumatic tibial bone infection combined with bone and soft tissue defects

作　　者：王刚[1] 章乐成 严超 吕胜松 张月雷 Wang Gang;Zhang Lecheng;Yan Chao;Lyu Shengsong;Zhang Yuelei(Department of Orthopedics,First Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徽医科大学第一附属医院创伤骨科,合肥230000

出　　处：《中华创伤杂志》2021年第3期210-215,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金(81702134)。

摘　　要：目的探讨Ilizarov骨搬运技术结合载万古霉素骨水泥垫块在胫骨创伤后骨感染合并骨与软组织缺损中的疗效。方法采用回顾性病例系列研究分析2016年6月至2019年6月安徽医科大学第一附属医院收治的11例胫骨创伤后骨感染合并骨与软组织缺损患者临床资料,其中男7例,女4例;年龄21~56岁[(41.5±12.1)岁]。清创后骨缺损长度(8.1±2.6)cm,软组织缺损面积(16.2±4.7)cm2。首先行骨感染灶清除、骨缺损区载万古霉素骨水泥垫块填充,然后行Ilizarov骨搬运治疗骨与软组织缺损。记录软组织对合时间、断端会师时间、外固定时间、外固定指数。末次随访时采用Johner-Wruhs评分评定疗效,采用美国矫形外科足踝协会(AOFAS)踝-后足评分评估踝关节功能。观察术后并发症情况。结果患者均获随访13~27个月[(17.9±4.5)个月]。软组织对合时间为48~155 d[(101.7±29.0)d],断端会师时间为55~167 d[(111.6±29.5)d],外固定时间为154~450 d[(322.9±86.3)d],外固定指数为31.1~61.5 cm/d[(40.8±7.5)cm/d]。末次随访时Johner-Wruhs评分评定效果:优2例,良4例,中5例。AOFAS踝-后足评分为61~94分[(76.6±12.7)分],其中优3例,良2例,可6例。4例患者行二次手术治疗,其中2例患者会师端愈合不良,经Ⅱ期植骨后骨折愈合。患者均未因软组织缺损行游离或局部转位皮瓣修复。随访过程中无发热、创面流脓、软组织坏死、神经血管损伤等并发症。结论Ilizarov骨搬运技术结合载万古霉素骨水泥垫块治疗胫骨创伤后骨感染合并骨与软组织缺损并发症少,在骨延长的同时可同时实现软组织的闭合。Objective To investigate the effect of lizarov bone transport technique combined with vancomyein bone cement for treatment of posttraumatic tibial bone infection combined with bone and soft tissue defects.Methods A retrospective case series study was performed on 11 patients with posttraumatie tibial bone infection combined with bone and soft tissue defects admitted to First Affiliated Hospital of Anhui Medical University fom June 2016 to June 2019.There were 7 males and 4 females,with age of 21-56 years.[(41.5±12.1)years].Afer debridement,the length of bone defect was 4-13.2 cm[(8.1±2.6)cm],and the area of soft tissue defect was 6.5-23.4 cm^(2)[(16.2±4.7)cm^(2)].All patients were treated firstly with debridement of bone infection and vancomyecin loaded bone cement pad flling,followed by lizarov technique to repair bone and soft tissue defects.The soft tissue docking time,fracture docking time,extemal fixation time and extermal fixation index were recorded.At the last follow-up,Johner wruhs score was used to evaluate the curative ffect and American Orthopedic Foot and Ankle Society(AOFAS)ankle hindfoot score to evaluate the ankle joint function.The postoperative complications were observed.Results All patients were fllowed up for 17-23 months[(17.9±4.5)months].The soft tssue docking time was 48-155 days[(101.7±29.0)days]and fracture docking time was 55-167 days[(111.6±29.5)days].The extemal fixation time was 154-450 days[(322.9±86.3)days]with an extemal fixation index of 31.1-61.5 cn/day[(40.8+7.5)cm/day].At the last fllow-up,the results were excellent in 2 patients,god in4 and fair in 5 based on Johner-Wruhs score.At the last follow-up,the AOFAS ankle hindfoot score was 61-94 points[(76.6±12.7)points],with excellent results in 3 patients,good in 2 and fair in 6.Four patients were treated with secondary operation,and two of them bad docking site nonunion which healed after secondary bone grafting.No free or local transposition flap repair was performed in regadless of soft tssue defect.During the follow-u

关 键 词：伊利扎罗夫技术 骨髓炎 胫骨 骨粘合剂 软组织损伤 

分 类 号：R687.3[医药卫生—骨科学]