诱导膜联合双向骨搬运治疗胫骨大段感染性骨缺损  

Membrane induction combined with bilateral bone transport for treatment of large-segment infected bone defect in tibia

作　　者：胡必军 韩培[2] 左镇华 徐铮宇[2] HU Bi-jun;HAN Pei;ZUO Zhen-hua;XU Zheng-yu(Department of Orthopedics,Dazhu County People's Hospital,Dazhu,Sichuan,635100,China)

机构地区：[1]大竹县人民医院骨科,四川省635100 [2]上海交通大学附属第六人民医院骨科,200233

出　　处：《中国骨与关节杂志》2025年第3期200-206,共7页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金面上项目(81974325);上海市科委自然基金面上项目(22ZR1447500)。

摘　　要：目的探讨应用诱导膜技术联合双向骨搬运技术治疗胫骨大段感染性骨缺损的治疗效果。方法回顾分析2018年1月至2022年12月我科收治的20例通过诱导膜技术联合双向骨搬运技术治疗的胫骨大段感染性骨缺损患者的临床资料,其中男15例,女5例;年龄22~64岁,平均(42.5±12.8)岁。经彻底清创后骨缺损长度6~14 cm,平均(9.5±2.3)cm。使用本研究方案治疗前手术2~5次,平均3.5次。本研究采用3个阶段方案治疗,分别为第一阶段清创、外支架固定、抗生素骨水泥填充,第二阶段胫骨近、远端截骨骨搬运,第三阶段对合端治疗。末次随访使用Ilizarov方法应用研究学会(Association for the Study of and Application of the Methods of Ilizarov,ASAMI)骨愈合及功能评价标准进行效果评估。结果所有患者拆除外固定后随访时间12~30个月,平均(18.0±4.9)个月。全部骨缺损都愈合良好,骨搬运时间45~90天,平均(62.5±13.4)天;延长区固化时间7~18个月,平均(11.3±2.8)个月;对合端愈合时间7.5(6.0~8.8)个月;外固定时间12(10.0~14.8)个月;外固定指数1.28(1.25~1.35)月/cm。按照ASAMI评价标准进行效果评估,骨愈合优17例、良3例,功能优16例、良4例。本组共出现针道感染7例,皮肤嵌顿6例,轴向偏移4例。结论诱导膜技术结合双向骨搬运技术治疗胫骨大段感染性骨缺损,能够彻底清除感染病灶,重建骨缺损,缩短外支架固定时间,安全有效,具有良好的临床效果。Objective To explore the therapeutic effect of membrane induction combined with bidirectional bone transport in the treatment of tibial large-segment infected bone defects.Methods A retrospective analysis of the clinical data of 20 patients with large-segment infected tibial bone defects who were treated with the induced membrane technique combined with bidirectional bone transport in our department from January 2018 to December 2022,including 15 males and 5 females,with a mean age of(42.5±12.8)years(range:22-64 years).Following a thorough debridement,the length of bone defects ranged from 6 to 14 cm,with a mean of(9.5±2.3)cm.Prior to this treatment regimen,all patients underwent 2 to 5 operations,with an average of 3.5 operations.In this study,we used a three-stage treatment regimen,including debridement,external fixation,and antibiotic-impregnated cement filling in the first stage,proximal and distal tibial osteotomies with bone transport in the second stage,and management of the docking site in the third stage.The results of the final follow-up were evaluated using Association for the Study of and Application of the Methods of Ilizarov(ASAMI)bone healing and functional evaluation criteria.Results All patients were followed up for 12 to 30 months after external fixator removal,with an average of(18.0±4.9)months.All bone defects healed well.Bone transport time ranged from 45 to 90 days,with an average of(62.5±13.4)days;consolidation time of the bone elongation zone ranged from 7 to 18 months,with an average of(11.3±2.8)months;the mean docking site healing time was 7.5 months(range:6.0-8.8 months);the mean external fixation time was 12 months(range:10.0-14.8 months);and the mean external fixation index was 1.28 months/cm(range:1.25-1.35 months/cm).According to ASAMI criteria,17 cases achieved excellent bone union and 3 cases achieved good union;16 cases achieved excellent functional outcomes and 4 cases achieved good outcomes.In this group,7 cases of pin track infection,6 cases of skin entrapment,and 4 cases

关 键 词：胫骨 感染 治疗结果 膜诱导技术 

分 类 号：R681.2[医药卫生—骨科学]