CAJ | 학술논문

目的探讨Ilizarov技术Ⅰ期治疗胫骨大段骨缺损合并软组织缺损的可行性.方法 2003年9月-2010年9月收治胫骨大段骨缺损合并软组织缺损患者24例,均为胫骨开放性骨折(Gustilo Ⅲ B型20例,Gustilo Ⅲ C型4例).在患肢上安放Ilizarov外固定架.清创术后小腿胫前内侧软组织缺损10 cm×6 cm,胫骨骨缺损(8±4)cm.对15例胫骨骨缺损＜5 cm的患者使用Ⅰ期清创、腓骨截骨、胫骨缺损端加压.对9例胫骨缺损＞5 cm的患者采用Ⅰ期清创、骨运输-骨延长.对15例患者采用Ⅰ期清创,封闭创面或缩小创面、骨搬移,Ⅱ期清理皮肤嵌顿及清理骨折端.结果所有患者随访10～24个月,平均14个月.骨缺损均得以重建,患肢肢体长度与健侧之差＜2 cm,骨折愈合,创面均闭合.1例术后出现腓总神经麻痹,术后3个月恢复.19例未通过额外手术进行修复.3例通过游离皮片植皮成活,2例通过局部旋转皮瓣修复覆盖创面.结论 Ⅰ期使用Ilizarov外固定架进行骨搬移肢体是治疗胫骨骨缺损合并软组织缺损的有效方法.
목적 탐토Ilizarov기술Ⅰ기치료경골대단골결손합병연조직결손적가행성.방법 2003년9월-2010년9월수치경골대단골결손합병연조직결손환자24례,균위경골개방성골절(Gustilo Ⅲ B형20례,Gustilo Ⅲ C형4례).재환지상안방Ilizarov외고정가.청창술후소퇴경전내측연조직결손10 cm×6 cm,경골골결손(8±4)cm.대15례경골골결손＜5 cm적환자사용Ⅰ기청창、비골절골、경골결손단가압.대9례경골결손＞5 cm적환자채용Ⅰ기청창、골운수-골연장.대15례환자채용Ⅰ기청창,봉폐창면혹축소창면、골반이,Ⅱ기청리피부감돈급청리골절단.결과 소유환자수방10～24개월,평균14개월.골결손균득이중건,환지지체장도여건측지차＜2 cm,골절유합,창면균폐합.1례술후출현비총신경마비,술후3개월회복.19례미통과액외수술진행수복.3례통과유리피편식피성활,2례통과국부선전피판수복복개창면.결론 Ⅰ기사용Ilizarov외고정가진행골반이지체시치료경골골결손합병연조직결손적유효방법.
Objective To explore the feasibility of Ilizarov technique in managing large tibia defects combined with soft tissue defects.Methods A total of 24 patients with large tibial defects combined with soft tissue defects caused by compound open tibial fractures were fixed with Ilizarov technique from September 2003 to September 2010.All patients belonged to open tibial fractures,including 20 patients with Gustilo type Ⅲ B and four with Gustilo type Ⅲ C.After debridement,the soft tissue defect areas was 10 cm ×6 cm and the bone defect was(8 ±4)cm.Fifteen patients with tibial defects ＜5 cm were treated with one stage debridement,fibula resection and tibial defect end compression.The other nine patients with tibial defect ＞ 5 cm were managed by one stage debridement,bone transport and bone lengthening.Then,15 patients were treated with one stage debridement,wound closure or wound reduction,bone grafting treatment and second stage cleansing of the incarcerated skin and fracture end.Results All patients were followed up for average 14 months(10-24 months),which showed reconstruction of the bone defects,restoration of the limb length,fracture healing and less than 2 cm difference between health limb and contralateral limb.One patient experienced common peroneal nerve palsy after operation,but recovered three months later.Of all,19 patients recovered without extra surgery,three restored with skin graft and two received skin flap.Conclusion Ilizarov technique is an effective option for treating the tibial defects combined with soft tissue defects at one stage.