骨短缩-延长术与载抗生素硫酸钙的骨搬运技术治疗创伤后胫骨大段骨缺损的疗效比较  

Comparison of acute shortening-lengthening and antibiotic calcium sulfate-loaded bone transport for the treatment of segmental tibial defects after trauma

作　　者：姬帅 马腾[1] 王谦[1] 李明[1] 任程[1] 戚鸿飞 崔玉[1] 杜兵[1,2] 杨彦玲 黄强[1] 李忠[1] 张堃[1] Ji Shuai;Ma Teng;Wang Qian;Li Ming;Ren Cheng;Qi Hongfei;Cui Yu;Du Bing;Yang Yanling;Huang Qiang;Li Zhong;Zhang Kun(Department of Trauma Orthopaedics,Xi'an Honghui Hospital Afiliated to Xi'an Jiaotong University,Xi'an 710054,China;Medical College of Yan'an University,Yan'an 716000,China)

机构地区：[1]西安交通大学附属红会医院创伤骨科,西安710054 [2]延安大学,延安716000

出　　处：《国际外科学杂志》2023年第3期149-155,F0003,共8页International Journal of Surgery

基　　金：陕西省自然科学基金(2022JQ-757,2022JQ-299)。

摘　　要：目的:比较骨短缩-延长术与载抗生素硫酸钙的骨搬运技术治疗创伤后胫骨大段骨缺损的临床效果。方法:采用回顾性病例对照研究的方法分析2014年5月—2019年12月西安交通大学附属红会医院收治的58例接受Ilizarov技术治疗的胫骨大段骨缺损患者的临床数据。根据手术方法分为两组,其中30例患者接受骨短缩-延长术治疗(A组),根据短缩情况不同将其分为术中一次性短缩成功患者(A1组,n=17)和需要术后逐渐短缩患者(A2组,n=13),28例患者接受载抗生素硫酸钙的骨搬运技术治疗(B组)。比较A组与B组患者的外固定架固定时间(EFT)、外固定指数(EFI),根据Ilizarov技术研究和应用协会(ASAMI)标准评估骨缺损愈合和肢体功能,同时根据Paley分类标准统计并发症情况。正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用t检验;计数资料以例(%)表示,组间比较采用χ^(2)检验、Fisher确切概率法或Mann-Whitney U检验。结果:58例患者术后均获随访,时间为(27.5±5.1)个月。A、B两组患者的一般资料比较差异均无统计学意义(P>0.05)。A、B两组患者的EFT、EFI、骨缺损愈合和肢体功能结果比较差异均无统计学意义(P>0.05)。A1组患者Ⅱ级钉道感染率[41.2%(7/17)]、Ⅲ级钉道感染率[47.1%(8/17)]及A2组患者Ⅱ级钉道感染率[46.2%(6/13)]、Ⅲ级钉道感染率[53.8%(7/13)]显著高于B组[14.3%(4/28)]、[17.9%(5/28)],差异有统计学意义(P<0.05)。A1组人均并发症数[(1.4±0.3)次/例]及A2组患者人均并发症数[(1.5±0.3)次/例]显著多于B组患者[(1.1±0.5)次/例],差异均有统计学意义(P<0.05)。结论:采用2种手术方法均可成功治愈胫骨大段骨缺损患者。与骨短缩-延长组相比,载抗生素硫酸钙的骨搬运组患者的并发症发生率更低,尤其是感染相关并发症。因此,载抗生素硫酸钙的骨搬运技术在感染或骨髓炎导致的大段骨缺损患者中具有更大的应用前景。Objective:To compare the clinical effects of acute shortening-lengthening technique with antibiotic calcium sulfate-loaded bone transport technique for the treatment of segmental tibial defects after trauma.Methods:The clinical data of 58 patients with large tibial defects treated by Ilizarov technique in Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from May 2014 to December 2019 were retrospectively analyzed.Thirty patients were treated by acute shortening-lengthening(group A),and they were divided into those who were successful in one-time shortening during operation(group A1)and those who needed gradual shortening after operation(group A2)according to different shortening conditions.And 28 patients by antibiotic calcium sulfate-loaded bone transport(group B).The external fixation time(EFT)and external fixation index(EFI)of the two groups were compared.Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov(ASAMI)criteria.Complications were compared by Paley classification.The measurement data of normal distribution were expressed as x±s,and t-test was used for comparison between groups;the count data were expressed as n(%),and the chi-square test,Fisher exact probability method or Mann-Whitney U test were used for comparison between groups.Results:Patients were followed for(27.5±5.1)months.There was no significant difference in EFT,EFI,bone defect healing and limb functions between the two groups(P>0.05).The incidence of Grade-Ⅱ[41.2%(7/17)],Grade-Ⅲ[47.1%(8/17)]pin-tract infection in group A1 and Grade-Ⅱ[46.2%(6/13)],Grade-Ⅲpin-tract[53.8%(7/13)]in group A2 was significantly higher than those in group B[14.3%(4/28)],[17.9%(5/28)](P<0.05).The number of complications per capita in group A1[(1.4±0.3)times/case]and in group A2[(1.5±0.3)times/case]was significantly higher than that in group B[(1.1±0.5)times/case].Conclusions:Patients can be cured successfully by both acute shortening-lengthening and

关 键 词：胫骨 感染 硫酸钙 骨延长术 伊利扎罗夫技术 

分 类 号：R687.3[医药卫生—骨科学]