双平面截骨骨搬移联合锁定钢板外置治疗胫骨大段骨缺损的疗效分析  

Biplane osteotomy and bone transport combined external locking plating for sequential treatment of massive tibial bone defects

作　　者：李善庆 胡锐[1] 朱进 安颖 杨春宝 严立[1] Li Shanqing;Hu Rui;Zhu Jin;An Ying;Yang Chunbao;Yan Li(Department of Repair and Reconstruction,Wuhan Puai Hospital(Wuhan No.4 Hospital),Tongji Medical College,Huazhong University of Scienceand Technology,Wuhan 430033,China)

机构地区：[1]华中科技大学同济医学院附属武汉普爱医院(武汉市第四医院)修复重建科,武汉430033

出　　处：《中华创伤骨科杂志》2022年第11期998-1002,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨双平面截骨骨搬移联合锁定钢板外置治疗胫骨大段骨缺损的疗效。方法回顾性分析2013年10月至2019年10月在华中科技大学同济医学院附属武汉普爱医院修复重建科接受治疗的28例胫骨骨缺损患者资料。根据方法不同分为骨搬移组和联合骨搬移组(骨搬移联合锁定钢板外置治疗)。骨搬移组14例,男10例,女4例;年龄(38.6±3.2)岁,骨缺损长度(8.0±0.5)cm。联合骨搬移组14例,男9例,女5例;年龄(39.1±3.9)岁,骨缺损长度(8.3±0.3)cm。比较两组患者外固定支架佩戴时间、骨折愈合时间、对接点愈合时间、功能评估及并发症发生情况等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。骨搬移组随访时间12~28个月,平均18.4个月;联合骨搬移组随访时间12~26个月,平均16.8个月。联合骨搬移组外固定支架佩戴时间(8.4±0.7)个月短于骨搬移组(13.3±1.4)个月,差异有统计学意义(P<0.05),骨折愈合时间分别为(8.4±1.3)、(7.4±1.2)个月,对接点愈合时间分别为(210.2±9.1)、(206.2±9.8)个月,以上两组间比较差异均无统计学意义(P>0.05)。ASAMI骨愈合评价:骨搬移组优6例,良5例,可3例;联合骨搬移组优8例,良4例,可2例;两组优良情况比较差异无统计学意义(P>0.05)。下肢功能评价:骨搬移组优7例,良3例,可3例,差1例;联合骨搬移组优8例,良5例,可1例,两组优良情况比较差异无统计学意义(P>0.05)。骨搬移组针道感染3例,对合端不愈合1例,下肢力线不良2例,皮肤下陷2例,固定针松动1例,关节僵硬5例,牵拉骨延迟愈合3例;联合骨搬移组针道感染1例,下肢力线不良2例,皮肤下陷3例,关节僵硬3例,牵拉骨延迟愈合2例,再骨折1例。结论双平面截骨骨搬移联合锁定钢板外置治疗下肢大段骨缺损,外固定支架佩戴时间更短,疗效更满意。Objective To evaluate biplane osteotomy and bone transport combined external locking plating for sequential treatment of massive tibial bone defects.Methods Twenty-eight patients with massive tibial bone defects were reviewed who had been treated at Department of Repair and Reconstruction,Wuhan Puai Hospital from October 2013 to October 2019.They were divided into a bone transport group and a combined bone transport group(bone transport combined external locking plating)according to their surgical methods.In the bone transport group of 14 cases,there were 10 males and 4 females with an age of(38.6±3.2)years and a bone defect of(8.0±0.5)cm;in the combined bone transport group of 14 cases,there were 9males and 5 females with an age of(39.1±3.9)years and a bone defect of(8.3±0.3)cm.The time for wearing external fixator,fracture healing time,dock-in-site healing time,postoperative function assessment and complications were observed and compared between the2groups.Results Therewas no significantdifference between the2 groups in their preoperative general data,showing they were comparable(P>0.05).The bone transport group were followed up for 12 to 28 months(average,18.4 months)and the combined bone transport group for 12 to 26 months(average,16.8 months).The time for wearing external fixator in the combined bone transport group[(8.4±0.7)months]was significantly shorter than that[(13.3±1.4)months]in the bone transport group(P<0.05).No significant difference was observed between the 2 groups in either the fracture healing time[(8.4±1.3)months versus(7.4±1.2)months]or the dock-in-site healing time[(210.2±9.1)months versus(206.2±9.8)months)(P>0.05).By the Association for the Study and Application of the Method of Ilizarov(ASAMI)scoring,the bone healing was excellent in 6,good in 5 and fair in 3 cases in the bone transport group while excellent in 8,good in 4 and fair in 2 cases in the combined bone transport group,showing no significant difference between the 2 groups in the excellent to good rate(P>0.05).By the

关 键 词：伊利扎罗夫技术 骨延长 外固定支架 胫骨骨折 骨缺损 

分 类 号：R687.3[医药卫生—骨科学]