CAJ | 학술논문

目的探讨Ilizarov骨搬运技术结合抗生素骨水泥间隔物治疗胫骨感染性不愈合的疗效. 方法回顾性分析2008年1月至2011年3月治疗的58例胫骨感染性不愈合患者资料,男38例,女20例;年龄18 ～51岁,平均29.4岁;静息感染27例,活动感染31例;受伤至此次手术时间为6 ～ 50个月,平均30.5个月.首先进行感染骨段切除、抗生素骨水泥间隔物植入,然后行Ilizarov骨搬运技术治疗骨缺损.软组织缺损较多无法闭合者先采用负压封闭引流装置覆盖,或断端适度短缩后行植皮覆盖或皮肤牵张术.末次随访时采用Paley骨与功能评分方法及患者满意度评定疗效. 结果所有患者术后获24 ～63个月(平均31.6个月)随访.所有创面均获良好软组织覆盖.骨延长长度为6～15 cm,平均9.2 cm.骨愈合指数为31 d/cm;带架时间为8～31个月,平均10.6个月.末次随访时Paley骨折愈合评分结果:优30例,良23例,可5例,优良率为91.4％;Paley功能评分结果:优28例,良18例,可12例,优良率为79.3％.患者满意度:非常满意35例,满意18例,一般5例,满意率为91.4％.18例患者出现针道感染,5例患者出现膝关节伸直受限,4例患者出现马蹄足畸形,l例患者出现断针.所有患者感染均治愈,双下肢等长,无感染复发. 结论 Ilizarov骨搬运技术结合抗生素骨水泥间隔物可重建骨缺损、避免感染复发,是治疗胫骨感染性不愈合较安全、有效的方法.
목적 탐토Ilizarov골반운기술결합항생소골수니간격물치료경골감염성불유합적료효. 방법 회고성분석2008년1월지2011년3월치료적58례경골감염성불유합환자자료,남38례,녀20례;년령18 ～51세,평균29.4세;정식감염27례,활동감염31례;수상지차차수술시간위6 ～ 50개월,평균30.5개월.수선진행감염골단절제、항생소골수니간격물식입,연후행Ilizarov골반운기술치료골결손.연조직결손교다무법폐합자선채용부압봉폐인류장치복개,혹단단괄도단축후행식피복개혹피부견장술.말차수방시채용Paley골여공능평분방법급환자만의도평정료효. 결과 소유환자술후획24 ～63개월(평균31.6개월)수방.소유창면균획량호연조직복개.골연장장도위6～15 cm,평균9.2 cm.골유합지수위31 d/cm;대가시간위8～31개월,평균10.6개월.말차수방시Paley골절유합평분결과:우30례,량23례,가5례,우량솔위91.4％;Paley공능평분결과:우28례,량18례,가12례,우량솔위79.3％.환자만의도:비상만의35례,만의18례,일반5례,만의솔위91.4％.18례환자출현침도감염,5례환자출현슬관절신직수한,4례환자출현마제족기형,l례환자출현단침.소유환자감염균치유,쌍하지등장,무감염복발. 결론 Ilizarov골반운기술결합항생소골수니간격물가중건골결손、피면감염복발,시치료경골감염성불유합교안전、유효적방법.
Objective To investigate the clinical efficacy of llizarov bone transport combined with antibiotic cement spacer in the treatment of tibial infected nonunion.Methods From January 2008 through March 2011,58 patients with tibial infected nonunion were treated in our department.They were 38 men and 20 women,aged from 18 to 51 years (average,29.4 years).There were 27 cases of resting infection and 31 ones of active infection.The duration from injury to surgery ranged from 6 to 50 months,averaging 30.5 months.They were treated first with excision of the infected bone segment and implantation of antibiotic cement spacers,followed by Ilizarov bone transport to repair the bone defect.Massive defects of soft tissue were reconstructed bv vacuum sealed drainage coverage or limb shortening before skin traction or skin-grafting.The clinical efficacy was assessed using the Paley's evaluation system and the patients' satisfaction at the last follow-up.Results The patients were followed up for 24 to 63 months (average,31.6 months).All the infections were controlled with good soft tissue coverage.The bone lengthening was from 6 to 15 cm (average,9.2 cm).The mean distraction index was 31 d/cm,and the mean duration of fixation was 10.6 months (range,from 8 to 31 months).According to the Paley's svstem,the bone union was excellent in 30,good in 23,and fair in 5 patients,with a good-to-excellent rate of 91.4％,the functional outcome was excellent in 28,good in 18,and fair in 12 patients,with a good-to-excellent rate of 79.3％.Thirty-five patients felt very satisfied,18 satisfied and 5 acceptable with the functional outcomes,with a satisfaction rate of 91.4％.Pin tract infection occurred in 18 cases,limited knee extension in 5,equinus deformity in 4 and pin breaking in one.Isometry of bilateral lower limbs was achieved in all cases without any relapse of infection.Conclusion Ilizarov bone transport combined with antibiotic cement spacers is one reliable and effective treatment of infected tibial nonunion.