CAJ | 학술논문

目的总结应用混合外固定架进行胫骨运输术和延长术结合胫骨距骨融合术或胫骨跟骨融合术治疗踝关节周围感染性骨折不愈合的结果.方法 2003年4月至2013年3月对26例胫骨远端合并距骨和跟骨感染性骨折不愈合的患者实施混合式外固定架固定术、清创术.清创术后胫骨远段及踝关节前内侧创面2 cm×4 cm～4 cm×8 cm.二期行胫骨近段截骨运输术,待胫骨与距骨或跟骨对接后行胫距或胫跟融合术.对治疗结果进行回顾性分析.结果患者均获得随访,随访时间22 ～ 38个月,平均32个月.胫骨近段截骨区新生骨长度为4～15 cm,平均8 cm.18例在对接端实施清创术,其中14例附加自体骨植骨术,3例合并腓骨缺损者直接短缩肢体,使胫骨与距骨加压,术后延长肢体至双下肢等长.待对接端骨折愈合、胫骨近段截骨运输处新生骨成熟后去除外固定架.平均带外固定架时间15个月.所有融合术均成功,感染无复发.2例在融合区出现6°内翻畸形.结论胫骨牵拉成骨术结合胫距融合术或胫跟融合是治疗踝关节周围感染性骨折不愈合特别是大段骨缺损的一种有效治疗方法.
목적 총결응용혼합외고정가진행경골운수술화연장술결합경골거골융합술혹경골근골융합술치료과관절주위감염성골절불유합적결과.방법 2003년4월지2013년3월대26례경골원단합병거골화근골감염성골절불유합적환자실시혼합식외고정가고정술、청창술.청창술후경골원단급과관절전내측창면2 cm×4 cm～4 cm×8 cm.이기행경골근단절골운수술,대경골여거골혹근골대접후행경거혹경근융합술.대치료결과진행회고성분석.결과 환자균획득수방,수방시간22 ～ 38개월,평균32개월.경골근단절골구신생골장도위4～15 cm,평균8 cm.18례재대접단실시청창술,기중14례부가자체골식골술,3례합병비골결손자직접단축지체,사경골여거골가압,술후연장지체지쌍하지등장.대대접단골절유합、경골근단절골운수처신생골성숙후거제외고정가.평균대외고정가시간15개월.소유융합술균성공,감염무복발.2례재융합구출현6°내번기형.결론 경골견랍성골술결합경거융합술혹경근융합시치료과관절주위감염성골절불유합특별시대단골결손적일충유효치료방법.
Objective To evaluate the results of managing the infected nonunions of distal tibial fractures combined with talar fracture and calcaneal fracture with tibial bone transport,tibiotalar or tibiocalcaneal arthrodesis using the hybrid external fixator.Methods A retrospective review of 26 patients who underwent either tibiotalar arthodesis or tibiocalcaneal arthodesis using an hybrid external fixator for infected nonunions of distal tibial fractures,talar and calcaneal fractures after tibial bone distraction was made.Each patient had a debridement of all infected and nonviable bones,the wound area were 2 cm × 4 cm-4 cm × 8 cm.The bony surfaces of distal tibia and talus were prepared for the fusion followed by application of an Orthofix's hybrid external fixator.Results The remaining 18 patients undertook debridement at the docking sites,and 14 of them had autogenous bone grafting.There was a mean follow-up of 32 months (22-38 months).All the patients had successful fusions.There were no recurrent deep infections or amputations.Two patients had 6°of varus deformity at the docking site.Conclusion Tibiotalar or tibiocalcaneal arthrodesis using the Ilizarov technique is viable alternative to amputation in patients with infected nonunions,especially if there is a large bone loss of the tibias,talus and calcaneus.