CAJ | 학술논문

目的探讨应用骨搬运治疗四肢大段骨缺损的临床疗效.方法骨搬运治疗四肢大段骨缺损29例,男23例,女6例;年龄18~53岁,平均30岁;骨缺损5~16cm,平均7.5cm.术前均摄双侧肢体等条件X线片,测量并记录骨缺损的长度,对于合并软组织缺损者在清创前后分别记录创面缺损面积.均在截骨术后10~14d开始骨搬运,每天4~6次,每次1/6~1/4mm.记录术后骨痂牵拉时间、骨痂直径率(CDR)、骨愈合时间、支架固定时间及活动功能情况,分析并进行疗效评定.结果随访18~31个月,平均24个月.18例移植皮瓣全部成活,伤口一期愈合.在骨搬运过程中,因牵拉皮肤导致不适而行皮肤切开调整:15例为一次,10例为两次,4例为三次.骨搬运时间45~158d,平均76.2d.根据CDR值及时调整牵拉速度,22例CDR≥85%,5例80%≤CDR<85%,2例CDR<80%.骨愈合时间5~14个月,平均8.7个月.外固定支架携带时间6~18个月,平均10.1个月.根据Paley等方法评价骨搬运结果及功能.骨搬运结果评价:优25例,良4例;功能评价:优15例,良10,可4例,优良率86.2%.结论应用Orthofix重建外固定架进行骨搬运是治疗四肢大段骨缺损的有效方法.骨搬运的起始速率为1mm/d,后根据CDR值及时调整,如CDR>85%,可加快为1.2mm/d;如CDR<80%,可减缓为0.5mm/d.
목적 탐토응용골반운치료사지대단골결손적림상료효.방법 골반운치료사지대단골결손29례,남23례,녀6례;년령18~53세,평균30세;골결손5~16cm,평균7.5cm.술전균섭쌍측지체등조건X선편,측량병기록골결손적장도,대우합병연조직결손자재청창전후분별기록창면결손면적.균재절골술후10~14d개시골반운,매천4~6차,매차1/6~1/4mm.기록술후골가견랍시간、골가직경솔(CDR)、골유합시간、지가고정시간급활동공능정황,분석병진행료효평정.결과 수방18~31개월,평균24개월.18례이식피판전부성활,상구일기유합.재골반운과정중,인견랍피부도치불괄이행피부절개조정:15례위일차,10례위량차,4례위삼차.골반운시간45~158d,평균76.2d.근거CDR치급시조정견랍속도,22례CDR≥85%,5례80%≤CDR<85%,2례CDR<80%.골유합시간5~14개월,평균8.7개월.외고정지가휴대시간6~18개월,평균10.1개월.근거Paley등방법평개골반운결과급공능.골반운결과평개:우25례,량4례;공능평개:우15례,량10,가4례,우량솔86.2%.결론 응용Orthofix중건외고정가진행골반운시치료사지대단골결손적유효방법.골반운적기시속솔위1mm/d,후근거CDR치급시조정,여CDR>85%,가가쾌위1.2mm/d;여CDR<80%,가감완위0.5mm/d.
Objective To evaluate the clinical results by using bone transport to treat the extensive bone defects of limbs. Methods 29 cases of limbs extensive bone defects were treated with bone transport. The patients included 23 males and 6 females, with an average age of 30 years (range, 18 to 53 years). The bone defects averaged 7.5cm (range, 5 to 16cm). X-ray photographs were taken bilateral at the same conditions in all patients. The length of the defects were measured on X-ray films and recorded. For the patients who combined with soft tissue defects, the defect area were recorded before and after debridement. Bone transport were performed on the tenth to fourteenth day postoperatively, according to four times per day and one quarter millimeter at one time or six times per day and one-sixth millimeter at one time. Postoperative callus distraction time, callus diameter ratios (CDR), bone union time, time of using external fixator and functional activities were recorded and analyzed. The clinical outcome were evaluated. Results The average followed-up was 24 months (range, 18 to 31 months). 18 explanted flap were all survival and primary wound healing. During callus distraction, because of skin discomfort, incision was made once for 15 patients, twice for 10 patients and three times for 4 patients. The mean bone transport time was 76.2 days (range, 45 to 158 days). According to Nakamura, there were 22 patients whose CDR≥85%, 5 patients whose 80%≤CDR<85%, 2 patients whose CDR< 80%. The mean bone union time was 8.7 months (range, 5 to 14 months). The mean time of carrying external fixator was 10.1 months (range, 6 to 18 months). According to Paley's evaluation system, 25 cases were excellent and 4 were good for bone union. 15 cases were excellent, 10 were good and 4 were fair for function evaluation. The excellent and good rate was 86.2%. Conclusion It is effective in the treatment of bone defect that bone transport with Orthofix limb reconstruction system. The velocity of bone transport is 1mm/d at beging. We can adjust the velocity of bone transport according to CDR range from 0.5 to 1.2mm/d.