CAJ | 학술논문

背景：既往尚无有效的方法彻底治疗胫骨骨缺损合并软组织缺损。Ilizarov技术的应用能在一定程度上解决短缩畸形、软组织损伤及关节挛缩等相关问题。 　　目的：探讨Ilizarov牵拉架外固定治疗胫骨骨缺损的效果及钢环的参数选择情况。 　　方法：回顾性分析2007年3月至2012年1月收治且获得完整随访的胫骨骨缺损67例患者的临床资料，所有患者均为既往有胫骨骨折并一期行手术治疗，治疗后有胫骨骨髓炎合并骨与软组织损伤，在患肢上安放Ilizarov环形架外固定。比较外固定后1，3，6个月及末次随访时胫骨缺损长度和软组织缺损面积，观察外固定前后踝关节Kofoed评分和膝关节ROM评分有无差异，末次随访时根据Johner-Wruhs胫骨干骨折诊疗评价标准评定功能恢复情况。 　　结果与结论：67例均得到随访，时间6-35个月。67例骨缺损得以重建，骨折愈合，但其中5例效果较差；44例软组织缺损病例中，40例创面闭合，4例创面未愈合。外固定后1，3，6个月及末次随访胫骨缺损长度和软组织缺损面积均较外固定前改善(P <0.05)；外固定后踝关节Kofoed评分及膝关节ROM均较外固定前改善(P<0.05)；末次随访时各种治疗方案疗效评价优良率为85%。对于合并皮肤缺损的胫骨骨髓炎性骨缺损，应用Ilizarov技术治疗胫骨骨缺损创伤小，能够避免多次复杂手术，缩短治疗时间和节省治疗费用，但也有一定的缺点和局限性。选用Ilizarov环形外固定架钢环的大小和材质对外固定效果和固定后调整均有一定影响。
배경：기왕상무유효적방법철저치료경골골결손합병연조직결손。Ilizarov기술적응용능재일정정도상해결단축기형、연조직손상급관절련축등상관문제。 　　목적：탐토Ilizarov견랍가외고정치료경골골결손적효과급강배적삼수선택정황。 　　방법：회고성분석2007년3월지2012년1월수치차획득완정수방적경골골결손67례환자적림상자료，소유환자균위기왕유경골골절병일기행수술치료，치료후유경골골수염합병골여연조직손상，재환지상안방Ilizarov배형가외고정。비교외고정후1，3，6개월급말차수방시경골결손장도화연조직결손면적，관찰외고정전후과관절Kofoed평분화슬관절ROM평분유무차이，말차수방시근거Johner-Wruhs경골간골절진료평개표준평정공능회복정황。 　　결과여결론：67례균득도수방，시간6-35개월。67례골결손득이중건，골절유합，단기중5례효과교차；44례연조직결손병례중，40례창면폐합，4례창면미유합。외고정후1，3，6개월급말차수방경골결손장도화연조직결손면적균교외고정전개선(P <0.05)；외고정후과관절Kofoed평분급슬관절ROM균교외고정전개선(P<0.05)；말차수방시각충치료방안료효평개우량솔위85%。대우합병피부결손적경골골수염성골결손，응용Ilizarov기술치료경골골결손창상소，능구피면다차복잡수술，축단치료시간화절성치료비용，단야유일정적결점화국한성。선용Ilizarov배형외고정가강배적대소화재질대외고정효과화고정후조정균유일정영향。
BACKGROUND:There was no effective method to thoroughly treat tibial bone defect and soft tissue defect. The application of Ilizarov technique solved shortening deformity, soft tissue injury and joint contracture to some degrees. OBJECTIVE:To discuss the effects of Ilizarov external fixation on treatment of tibial bone defect and the parameter selection of Ilizarov steel ring. METHODS:We retrospectively analyzed the clinical data of 67 patients with tibial bone defects, who were treated and fol owed up from March 2007 to January 2012. Al patients had fracture of tibia and received one-stage operation. After treatment, postoperative limb suffered from tibia osteomyelitis and soft tissue injury. Ilizarov external fixation was placed in the limb. The length of defected tibia and area of defected soft tissues were compared at 1, 3 and 6 months after external fixation and final fol ow-up. The ankle joint Kofoed score and knee joint ROM score were observed before and after external fixation. In final fol ow-up, functional recovery was evaluated in accordance with diagnosis and treatment criteria of Johner-Wruhs fracture of shaft of tibia. RESULTS AND CONCLUSION:A total of 67 patients were fol owed up for 6 to 35 months. Bone defects in 67 cases were rebuilt and the fracture was healed, but five cases had poor healing. Among 44 cases of soft tissue injury, wound had healed in 40 cases, and wound had not healed in 4 cases. The length of tibia defect and the area of soft tissue defects were improved at 1, 3, and 6 months after the operation (P<0.05). After operation, the ankle joint Kofoed score and knee joint ROM were significantly better than those before operation (P<0.05). During final fol ow-up, the excellent and good rate of each therapeutic plan was 85%. For the tibial osteomyelitis bone defect with the merged skin defect, the trauma was smal using Ilizarov technique, which can avoid several complicated operations, shorten the time and reduce the expenses of treatment, but there were some weaknesses and limitations. The size and material of Ilizarov external fixation affect the efficiency of the fixation and postfixation adjustment.