CAJ | 학술논문

目的探讨应用外固定支架骨搬运技术一期修复胫骨缺损合并软组织缺损的可行性及疗效.方法回顾性分析2006年2月至2012年10月收治的7例小腿开放性损伤合并复合组织缺损患者,男4例,女3例;平均年龄为31.8岁(16 ～52岁).7例患者开放性骨折均为GustiloⅢB型,其中3例合并感染,下肢严重创伤评分平均为4.8分(4～6分).清创后小腿软组织缺损面积平均为30.4cm2(12 ～ 70 cm2),胫骨缺损长度平均为9.2 cm(4～ 17 cm).4例近中段缺损患者采用胫骨远端截骨向近端骨搬运修复,3例中远段缺损患者采用胫骨近端截骨向远端骨搬运修复.创面采用负压封闭引流技术覆盖或碘伏纱布填塞.结果 7例患者术后获平均19.3个月(9～ 36个月)随访.7例患者骨缺损全部获愈合,其中5例一期愈合;2例骨搬运到位后对接端出现骨不连,植骨后愈合.骨愈合指数(愈合时间/缺损长度)平均为1.8个月/cm.7例患者软组织缺损面积均不同程度缩小,其中6例一期愈合,1例植皮后愈合.创面愈合时间平均为3.3个月(2.5 ～6.0个月).本组2例患者出现马蹄内翻足畸形,1例患者发生钉道感染,1例患者出现踝关节僵硬,1例患者出现膝关节僵硬.结论外固定支架骨搬运技术一期修复胫骨缺损合并软组织缺损操作简单、疗效确实,值得临床推广应用.
목적 탐토응용외고정지가골반운기술일기수복경골결손합병연조직결손적가행성급료효.방법 회고성분석2006년2월지2012년10월수치적7례소퇴개방성손상합병복합조직결손환자,남4례,녀3례;평균년령위31.8세(16 ～52세).7례환자개방성골절균위GustiloⅢB형,기중3례합병감염,하지엄중창상평분평균위4.8분(4～6분).청창후소퇴연조직결손면적평균위30.4cm2(12 ～ 70 cm2),경골결손장도평균위9.2 cm(4～ 17 cm).4례근중단결손환자채용경골원단절골향근단골반운수복,3례중원단결손환자채용경골근단절골향원단골반운수복.창면채용부압봉폐인류기술복개혹전복사포전새.결과 7례환자술후획평균19.3개월(9～ 36개월)수방.7례환자골결손전부획유합,기중5례일기유합;2례골반운도위후대접단출현골불련,식골후유합.골유합지수(유합시간/결손장도)평균위1.8개월/cm.7례환자연조직결손면적균불동정도축소,기중6례일기유합,1례식피후유합.창면유합시간평균위3.3개월(2.5 ～6.0개월).본조2례환자출현마제내번족기형,1례환자발생정도감염,1례환자출현과관절강경,1례환자출현슬관절강경.결론 외고정지가골반운기술일기수복경골결손합병연조직결손조작간단、료효학실,치득림상추엄응용.
Objective To explore the curative efficacy of simultaneous treatment of tibial bone and soft-tissue defects with external fixator and bone transport.Methods From February 2006 to October 2012,7 patients with tibial bone and soft tissue defects were treated by bone transport at our department.They were 4 men and 3 women,with an average age of 31.8 years (from 16 to 52 years).All their fractures were Gustlio type Ⅲ B and 3 of them were complicated with infection.Their average Mangled Extremity Severity Score (MESS) was 4.8 points (from 4 to 6 points).Their average soft tissue loss after debridement was 30.4 cm2 (from 12 to 70 cm2),and their average bone defect was 9.2 cm long (from 4 to 17 cm).Distal tibial osteotomy for proximal migration to repair the bone defect was used in 4 cases of proximal tibial defect while proximal tibial osteotomy for distal migration was used in the other 3 cases of distal defect.The wounds were covered by vacuum sealing drainage (VSD) dressing or filled with povidone-iodine gauze.Results The average follow-up period was 19.3 months (from 9 to 36 months).Bone defects were repaired in all.Primary bone healing was achieved in 5 cases while bone grafting had to be performed in the other 2 cases to repair bone non-union after bone transport.The average healing index (healing time/defect length) was 1.8 month/cm.The wounds were healed in all the 7 cases,6 of which obtained primary healing and one of which healed after skin grafting.The average time for wound healing was 3.3 months (from 2.5 to 6.0 months).Footdrop was observed in 2 cases and pin track infection in one.Conclusion Simultaneous treatment of complex defects at lower extremity with external fixator and bone transport should be recommended,because it is simple and efficient.