CAJ | 학술논문

目的探讨二处截骨骨搬运治疗胫骨干大段感染性骨缺损合并软组织缺损的疗效及并发症发生情况. 方法回顾性分析2009年5月至2014年5月收治的25例胫骨干大段感染性骨缺损合并软组织缺损患者资料,男23例,女2例;年龄2 ～52岁,平均31.2岁.骨折分型均为GustiloⅢB型.胫前软组织缺损面积为8 cm×4cm～24cm×12cm,胫骨干缺损长度为8.5 ～ 18.2 cm,平均12.3cm.清创后采用半环槽外固定支架或Ilizarov外固定支架固定,胫骨远、近干骺端截骨向胫骨中部骨搬运,术后近端截骨端起始骨搬运速度为1 mm/d,远端速度为0.6 mm/d;根据情况逐步降低至0.5～0.6 mm/d,直至骨端对合,患者搬移时间为40 ～ 150 d,平均69.6d.结果 25例患者术后获12 ～72个月(平均26.6个月)随访.软组织缺损创面全部愈合,骨缺损获重建.22例患者骨断端一期愈合,1例患者出现骨断端不愈合,1例患者出现骨延长区伤口感染及成骨不良,1例患者出现胫骨端骨质疏松克氏针切割拔出,分别行对症处理后骨获愈合.2例患者出现严重钉道感染,1例患者拆除外固定支架后出现再骨折,2例患者出现胫骨力线偏移,经对症处理后消失. 结论二处截骨可以有效缩短胫骨大段感染性骨缺损合并软组织缺损的骨搬运时间,疗效良好,但应注意手术细节和并发症的处理.
목적 탐토이처절골골반운치료경골간대단감염성골결손합병연조직결손적료효급병발증발생정황. 방법 회고성분석2009년5월지2014년5월수치적25례경골간대단감염성골결손합병연조직결손환자자료,남23례,녀2례;년령2 ～52세,평균31.2세.골절분형균위GustiloⅢB형.경전연조직결손면적위8 cm×4cm～24cm×12cm,경골간결손장도위8.5 ～ 18.2 cm,평균12.3cm.청창후채용반배조외고정지가혹Ilizarov외고정지가고정,경골원、근간후단절골향경골중부골반운,술후근단절골단기시골반운속도위1 mm/d,원단속도위0.6 mm/d;근거정황축보강저지0.5～0.6 mm/d,직지골단대합,환자반이시간위40 ～ 150 d,평균69.6d.결과 25례환자술후획12 ～72개월(평균26.6개월)수방.연조직결손창면전부유합,골결손획중건.22례환자골단단일기유합,1례환자출현골단단불유합,1례환자출현골연장구상구감염급성골불량,1례환자출현경골단골질소송극씨침절할발출,분별행대증처리후골획유합.2례환자출현엄중정도감염,1례환자탁제외고정지가후출현재골절,2례환자출현경골력선편이,경대증처리후소실. 결론 이처절골가이유효축단경골대단감염성골결손합병연조직결손적골반운시간,료효량호,단응주의수술세절화병발증적처리.
Objective To evaluate the techniques of bifocal corticotomy and bone transport for large segmental defects of the infected tibia and soft tissue and their complications as well.Methods From May,2009 to May,2014,25 patients with large segmental defects of the infected tibia and soft tissue were treated at our center.They were 23 males and 2 females,from 2 to 52 years of age (average,31.2 years).All the cases were Gustilo type Ⅲ B.The defect size of the soft tissue ranged from 8 cm ×4 cm to 24 cm × 12 cm;the length of tibia defects was from 8.5 cm to 18.2 cm,averaging 12.3 cm.After debridement,the tibia was fixated with Ilizarov external fixator.Bifocal corticotomy was performed on the proximal and distal tibial metaphyses simultaneously.The transporting speeds for proximal and distal tibial segment were 1 mm/d and 0.6 mm/d initially,and lowered to 0.5 ～ 0.6 mm/d later until the 2 bone segments connected.The bone transport lasted for 40 to 150 days,averaging 69.6 days.Results The patients were followed up for 12 to 72 months (average,26.6 months).The soft tissue wound healed uneventfully and the bone defects were reconstructed.Of the 25 cases,22 obtained primary bone union.Nonunion of the bone segments occurred in one,wound infection and osteogenesis imperfect in bone lengthening area occurred in one,and cut and pull-out of K-wires in the osteoporotic tibial ends occurred in one.These complications were treated accordingly before bone union was achieved.The other complications were also treated accordingly,including serious pin tract infection in 2 cases,re-fracture after removal of the external fixator in one,and shift of the tibial alignment in 2 cases.Conclusions Bifocal corticotomy can decrease bone transport time for large segmental defects of the tibia and soft tissue.During the long treatment period,a surgeon must pay much attention to the technical details and management of complications.