保留原有内固定一期手术治疗伴有软组织缺损的胫骨中下段感染性骨不连  

The feasibility and clinical effect of one-stage operation for the treatment of infected nonunion of the middle and lower tibia with soft tissue defects without retaining the original internal fixation

作　　者：陈蕾 黄凯[1] Chen Lei

机构地区：[1]浙江省立同德医院,310012

出　　处：《浙江临床医学》2023年第3期330-332,共3页Zhejiang Clinical Medical Journal

基　　金：国家自然科学基金资助项目(81603644);浙江省医药卫生科技计划项目(2023RC142)。

摘　　要：目的探讨保留原有内固定的前提下一期手术治疗伴有软组织缺损的胫骨中下段感染性骨不连手术方式的可行性及临床效果。方法回顾性分析2010年1月至2016年1月在本院就诊的胫骨中下段感染性骨不连患者21例。患者均在彻底清创的基础上,对骨折端植入自体髂骨及载抗生素人工骨,再行胫后动脉穿支蒂皮瓣修复软组织缺损,患者均保留了原有的内固定。结果本组术后两例皮瓣发生了血管危象,及时处理后缓解,所有病例随访时间为3.5~6.0年,患者均达到了皮瓣成活、骨折愈合、感染控制、功能恢复的治疗目的。结论保留原有内固定一期手术治疗伴有软组织缺损的胫骨中下段感染性骨不连,本方法既保留了原有内固定,又控制了感染,还治愈了骨不连,不失为一种有效可行的手术方式。Objective To explore the feasibility and clinical effect of one-stage operation for the treatment of infected nonunion of the middle and lower tibia with soft tissue defects without retaining the original internal fixation.Methods A retrospective analysis was performed on 21 patients with infectious nonunion of the middle and lower tibia from January 2010 to January 2016.On the basis of thorough debridement,the patients implanted autologous iliac bone and antibiotic loaded artificial bone at the fracture end,and then repaired the soft tissue defect with the skin flap pedicled with the perforating branch of the posterior tibial artery.All patients retained the original internal fixation.Results The vascular crisis occurred in the two flaps in this group after the operation,which was relieved after timely treatment.The follow-up time of all cases was 3.5 to 6 years.All patients achieved the treatment goals of flap survival,fracture healing,infection control and functional recovery.Conclusion The primary operation of retaining the original internal fixation to treat the infected nonunion of the middle and lower tibia with soft tissue defect is an effective and feasible operation method,which not only retains the original internal fixation,but also controls the infection and cures the nonunion.

关 键 词：保留内固定 一期手术 软组织缺损 胫骨感染性骨不连 

分 类 号：R687.3[医药卫生—骨科学]