单平面截骨骨搬移联合髓内钉治疗胫骨骨缺损  

Single-level osteotomy and bone transfer combined with intramedullary nail in the treatment of tibial bone defect

作　　者：涂振兴 王斌[2] 卢爱东[3] 张顶顶 杨焕友[2] 王辉[2] 王伟[2] 宫中平[2] 李力更[2] Tu Zhenxing;Wang Bin;Lu Aidong;Zhang Dingding;Yang Huanyou;Wang Hui;Wang Wei;Gong Zhongping;Li Ligeng(Graduate School of North China University of Science and Technology,Tangshan 063000,Hebei Province,China;Department of Hand Surgery,Repair and Reconstruction Surgery,Lower limb Vascular Disease,Tangshan Second Hospital,Tangshan 063000,Hebei Province,China;Kailuan General Hospital,Tangshan 063000,Hebei Province,China)

机构地区：[1]华北理工大学研究生学院,河北省唐山市063000 [2]唐山市第二医院手外科、修复重建外科、下肢血管病科,河北省唐山市063000 [3]开滦总医院,河北省唐山市063000

出　　处：《中国组织工程研究》2022年第12期1849-1853,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:骨搬移是治疗各种原因导致的骨缺损的有效手段,但外固定架佩戴时间长、延长骨长度丢失、弯曲畸形等并发症的存在限制了其应用。目的:探索单平面截骨骨搬移联合髓内钉与单纯单平面截骨治疗胫骨骨缺损的疗效差异。方法:选择2011年1月至2018年4月唐山市第二医院收治的胫骨骨缺损患者,纳入15例进行单平面截骨骨搬移联合髓内钉治疗的患者(试验组)与30例进行单纯单平面截骨骨搬移治疗的患者(对照组)。治疗后以门诊随诊、电话、微信视频相结合的方式进行随访,比较两组患者再生区矿化时间、愈合指数、外固定时间、外固定指数、对接点愈合情况、针道感染、再骨折等情况,采用Ilizarov方法研究与应用学会(ASAMI)评分标准进行骨愈合和功能评价。结果与结论:(1)两组患者获得(31.0±7.3)个月随访,拆除外架后切口无红肿、疼痛,针道感染均被控制;(2)两组患者再生区矿化时间、愈合指数、再骨折率和对接点愈合情况比较差异均无显著性意义(P>0.05),试验组外固定指数小于对照组(P<0.05),进行清理骨端、植骨的患者数量少于对照组(P<0.05),针道感染发生率低于对照组(P<0.05);(3)试验组患者ASAMI骨愈合与功能评分均优于对照组(P<0.05);(4)结果表明,与单平面截骨骨搬移比较,单平面截骨骨搬移联合髓内钉治疗胫骨骨缺损可缩短带架时间、降低术后清理骨端再植骨加压的概率、避免针道感染。BACKGROUND:Bone transfer is an effective treatment of bone defect caused by various causes.However,the complications,such as long wearing time of the external fixator,the loss of extended bone length,and bending deformities,restrict its application.OBJECTIVE:To explore the difference in the efficacy of single-level osteotomy combined with intramedullary nail and single-level osteotomy in the treatment of tibial bone defect.METHODS:Patients with tibial bone defect were selected from Tangshan Second Hospital from January 2011 to April 2018.Fifteen patients treated with singlelevel osteotomy and bone transfer combined with intramedullary nail were used as the trial group.Thirty patients treated with single-level osteotomy and bone transfer were used as the control group.After treatment,follow-up was carried out by the combination of outpatient follow-up,phone call and Wechat video.The mineralization time of regeneration area,healing index,external fixation time,external fixation index,joint healing,needle infection,and refracture were compared between the two groups.The scoring standard of Association of Study and Application on Method of Ilizarov was used to evaluate the bone healing and function.RESULTS AND CONCLUSION:(1)The patients in both groups were followed up for(31.0±7.3)months.The incision had no redness,swelling,or pain,and needle tract infection were controlled after removal of the outer frame.(2)There was no significant difference in mineralization time,healing index,refracture rate,and joint healing between the two groups(P>0.05).The external fixation index was smaller in the trial group than that in the control group(P<0.05).Number of patients with bone end cleaning and bone grafting was smaller in the trial group than that in the control group(P<0.05).The rate of needle tract infection was lower in the trial group than that in the control group(P<0.05).(3)ASAMI score was better in the trial group than that in the control group(P<0.05).(4)It is concluded that compared with the single-level osteotomy

关 键 词：髓内钉 骨搬移 ILIZAROV技术 胫骨骨缺损 环形外固定架 愈合指数 外固定指数 对接点 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]