双平面截骨骨搬运联合髓内钉治疗胫骨大段骨缺损  

Biplanar osteotomy and bone transport combined with intramedullary nailing for large segmental tibial bone defects

作　　者：程康 王斌[2] 涂振兴 吕梓宸 王子鑫 许奥 Cheng Kang;Wang Bin;Tu Zhenxing;Lyu Zichen;Wang Zixin;Xu Ao(Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,Hebei Province,China;Tangshan Second Hospital,Tangshan 063000,Hebei Province,China)

机构地区：[1]华北理工大学附属医院,河北省唐山市063000 [2]唐山市第二医院,河北省唐山市063000

出　　处：《中国组织工程研究》2023年第13期2058-2063,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:传统的Ilizarov骨搬移技术治疗长骨大段骨缺损虽然疗效较好,但由于佩戴外固定时间长、骨弯曲畸形、延长区的回缩、再骨折等因素,影响了骨搬移的临床效果。而双平面截骨骨搬运联合髓内钉有诸多优势。目的:对双平面截骨骨搬运联合髓内钉治疗胫骨大段骨缺损进行疗效分析。方法:回顾性分析了2016年7月至2020年6月收治的胫骨大段骨缺损8例患者,其中男7例,女1例;年龄33-50岁,平均39.3岁;致伤原因:车祸伤5例,重物砸伤3例;清创后皮肤缺损6.5 cm×1.3 cm-23.1 cm×9.7 cm,平均10.01 cm×5.51 cm;胫骨缺损长度6.8-12.1 cm,平均9.2cm。所有患者均采用双平面截骨骨搬运联合髓内钉治疗胫骨大段骨缺损。2例患者骨缺损部位位于胫骨中段,在胫骨近端及远端进行双平面截骨后置入髓内钉并在其远近端用锁钉固定,两端骨块向中间进行搬运;6例患者骨缺损部位位于胫骨远端,在胫骨近端进行双平面截骨,随后置入髓内钉并在其远近端用锁钉固定,近端两骨块顺行搬运。记录患者的骨搬移时间、牵拉区固化时间、愈合指数、外固定时间、外固定指数及并发症;应用Ilizarov方法研究与应用协会评分标准评价骨愈合和肢体功能。结果与结论:①8例患者术后均获得随访,随访时间19-33个月;所有患者均获骨性愈合,治疗期间未发生感染及复发;②骨搬移时间36-62d,平均50.2d;牵拉区固化时间267-512d,平均366.9d;愈合指数1.18-1.41个月/cm,平均1.31个月/cm;外固定时间5.5-12.5个月,平均8.3个月;外固定指数0.73-0.99个月/cm,平均0.86个月/cm;③对接点不愈合患者有3例;④依据Ilizarov方法研究与应用协会评分标准评价骨愈合:优5例(62%),差3例(38%);功能结果:优6例(75%),良2例(25%);⑤提示双平面截骨骨搬移联合髓内钉可明显缩短外固定时间,降低针道感染、对位对线不良、延长区再骨折等并发症的发生概率,为治疗胫骨大段�BACKGROUND:The traditional Ilizarov bone transfer technique is used to treat large segmental bone defects of long bones.Although the curative effect is good,due to factors such as the length of wearing external fixation,bone bending deformity,retraction of the extension zone,and refracture,it affects the clinical effect of bone transfer.Biplanar osteotomy and bone transport combined with intramedullary nailing has many advantages.OBJECTIVE:To analyze the effect of biplanar osteotomy and bone transport combined with intramedullary nailing in the treatment of large segmental tibial bone defects.METHODS:A retrospective analysis was performed on eight patients with large segmental tibial bone defects who were admitted from July 2016 to June 2020,including seven males and one female,with an average age of 39.3 years(33-50 years old).Causes of injury:five cases were injured by traffic accident and three cases were injured by heavy objects.After debridement,the skin defect ranged from 6.5 cm×1.3 cm to 23.1 cm×9.7 cm,with an average of 10.01 cm×5.51 cm.The length of the tibial defect was 6.8-12.1 cm(averagely 9.2 cm).All patients were treated with biplanar osteotomy and bone transport combined with intramedullary nailing for the treatment of large segmental tibial bone defects.In two patients,the bone defect was located in the middle of the tibia.After biplanar osteotomy was performed at the proximal and distal ends of the tibia,intramedullary nails were placed and fixed with locking nails at the distal and proximal ends.The bone fragments at both ends were transported to the middle.In six patients,the bone defect was located at the distal end of the tibia,and a biplanar osteotomy was performed at the proximal end of the tibia.An intramedullary nail was placed and fixed with locking nails at the distal and proximal ends.The proximal two bone fragments were transported anterogradely.The bone migration time,the mineralization time of the traction zone,the healing index,the external fixation time,the external fixation in

关 键 词：ILIZAROV技术 骨搬移 髓内钉 环式外固定架 胫骨骨缺损 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687