中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2014年
5期
370-373
,共4页
骨搬移术%胫骨骨折%感染%大段骨缺损%延长架
骨搬移術%脛骨骨摺%感染%大段骨缺損%延長架
골반이술%경골골절%감염%대단골결손%연장가
bone transport technique%tibial fracture%infection%large segmental bone defect%extension frame
背景：胫骨骨折术后感染性大段骨缺损的发生率高，治疗困难，效果不理想。目前，骨缺损修复方法包括皮瓣覆盖+自体骨移植术、异体骨或异种骨移植、带血供腓骨移植、骨延长和骨搬移术。<br> 目的：探讨骨搬移术治疗胫骨骨折术后感染性大段骨缺损的疗效。<br> 方法：选取2010年9月至2014年9月收治的胫骨骨折术后感染性大段骨缺损患者40例，男24例，女16例；年龄18~64岁，平均（42.8±12.1）岁。将患者随机分成两组各20例，一组采用Orthofix单臂外固定延长架截骨延长，另一组采用Ilizarov环形外固定延长架截骨延长，术后随访对比两组患者的手术时间、手术出血量、HHS膝关节功能评分、Baird-Jackson踝关节功能评分。<br> 结果：Orthofix单臂外固定延长架的手术时间较短、手术出血量较少，与Ilizarov环形外固定延长架比较均有统计学差异（P＜0.05）。两组患者的术后HHS膝关节功能评分、Baird-Jackson踝关节功能评分均较术前有明显提高（P＜0.01）。<br> 结论：骨搬移术治疗胫骨骨折术后感染性大段骨缺损的疗效佳，可较好地改善患者的膝关节和踝关节功能。其中Or-thofix单臂外固定延长架能减少手术创伤，安全性较高，但骨搬运过程中容易发生延长骨成角和偏移；Ilizarov环形外固定延长架的术中应用置入较多钢针，移动时可造成部分皮瓣坏死和血管损伤，应避免在皮瓣覆盖创面的胫骨大段骨缺损患者中使用。
揹景：脛骨骨摺術後感染性大段骨缺損的髮生率高，治療睏難，效果不理想。目前，骨缺損脩複方法包括皮瓣覆蓋+自體骨移植術、異體骨或異種骨移植、帶血供腓骨移植、骨延長和骨搬移術。<br> 目的：探討骨搬移術治療脛骨骨摺術後感染性大段骨缺損的療效。<br> 方法：選取2010年9月至2014年9月收治的脛骨骨摺術後感染性大段骨缺損患者40例，男24例，女16例；年齡18~64歲，平均（42.8±12.1）歲。將患者隨機分成兩組各20例，一組採用Orthofix單臂外固定延長架截骨延長，另一組採用Ilizarov環形外固定延長架截骨延長，術後隨訪對比兩組患者的手術時間、手術齣血量、HHS膝關節功能評分、Baird-Jackson踝關節功能評分。<br> 結果：Orthofix單臂外固定延長架的手術時間較短、手術齣血量較少，與Ilizarov環形外固定延長架比較均有統計學差異（P＜0.05）。兩組患者的術後HHS膝關節功能評分、Baird-Jackson踝關節功能評分均較術前有明顯提高（P＜0.01）。<br> 結論：骨搬移術治療脛骨骨摺術後感染性大段骨缺損的療效佳，可較好地改善患者的膝關節和踝關節功能。其中Or-thofix單臂外固定延長架能減少手術創傷，安全性較高，但骨搬運過程中容易髮生延長骨成角和偏移；Ilizarov環形外固定延長架的術中應用置入較多鋼針，移動時可造成部分皮瓣壞死和血管損傷，應避免在皮瓣覆蓋創麵的脛骨大段骨缺損患者中使用。
배경：경골골절술후감염성대단골결손적발생솔고，치료곤난，효과불이상。목전，골결손수복방법포괄피판복개+자체골이식술、이체골혹이충골이식、대혈공비골이식、골연장화골반이술。<br> 목적：탐토골반이술치료경골골절술후감염성대단골결손적료효。<br> 방법：선취2010년9월지2014년9월수치적경골골절술후감염성대단골결손환자40례，남24례，녀16례；년령18~64세，평균（42.8±12.1）세。장환자수궤분성량조각20례，일조채용Orthofix단비외고정연장가절골연장，령일조채용Ilizarov배형외고정연장가절골연장，술후수방대비량조환자적수술시간、수술출혈량、HHS슬관절공능평분、Baird-Jackson과관절공능평분。<br> 결과：Orthofix단비외고정연장가적수술시간교단、수술출혈량교소，여Ilizarov배형외고정연장가비교균유통계학차이（P＜0.05）。량조환자적술후HHS슬관절공능평분、Baird-Jackson과관절공능평분균교술전유명현제고（P＜0.01）。<br> 결론：골반이술치료경골골절술후감염성대단골결손적료효가，가교호지개선환자적슬관절화과관절공능。기중Or-thofix단비외고정연장가능감소수술창상，안전성교고，단골반운과정중용역발생연장골성각화편이；Ilizarov배형외고정연장가적술중응용치입교다강침，이동시가조성부분피판배사화혈관손상，응피면재피판복개창면적경골대단골결손환자중사용。
Background:There are high incidences of infectious large segmental bone defect after surgical treatment for tibial fracture, and it is very difficult to be cured. At present, there are a few of methods for repairing bone defect, such as skin flap cover-age plus autogenous bone transplantation, allograft bone or xenogeneic bone transplantation, vascularized fibular graft, bone lengthening and bone transport technique. <br> Objective:To explore the curative effect of bone transport technique in treating infectious large segmental bone defect after surgery for tibial fracture. <br> Methods:Forty patients with infectious large segmental bone defect after tibial fracture operation admitted to our hospital from September 2010 to September 2014 were enrolled in the study and randomly divided into two groups. Osteotomy was performed in group A by Orthofix external fixing lengthening, and osteotomy was performed in group B by Ilizarov ring fix-ing lengthening. Operation time, blood loss, HHS knee function score, Baird-Jackson ankle function score were compared between groups. <br> Results:Compared to those in Ilizarov group, the operation time was significantly shortened and intraoperative blood loss was significantly decreased (P<0.05). HHS knee function score and Baird-Jackson ankle function score were significantly increased after surgery in all patients (P<0.01). <br> Conclusions:The bone transport technique can achieve good curative effect on infectious large segmental bone defect after tibial fracture operation. Both Orthofix external fixing lengthening and Ilizarov ring fixing lengthening can improve the knee and ankle joint function. The former can reduce the operation trauma and increase operation safety, but malunion and offset may occur in the procedure. More intraoperative needles will be implanted in Ilizarov lengthening, and skin flap ne-crosis and vascular injury may occur when moving. So it can not be used in the patients with large segment bone defect of tibia and the wound covered with skin flap.
