中国综合临床
中國綜閤臨床
중국종합림상
Clinical Medicine of China
2015年
10期
945-947
,共3页
于立志%王光敏%李凌云%刘永华%梅克海
于立誌%王光敏%李凌雲%劉永華%梅剋海
우립지%왕광민%리릉운%류영화%매극해
Ilizarov技术%急性胫骨骨髓炎%大面积软组织坏死
Ilizarov技術%急性脛骨骨髓炎%大麵積軟組織壞死
Ilizarov기술%급성경골골수염%대면적연조직배사
Ilizarov technique%Acute fibial infection%Soft tissue defection
目的 分析Ilizarov技术结合换药治疗急性胫骨骨髓炎伴大面积软组织坏死的效果.方法 回顾性分析2009年7月至2012年9月14例急性胫骨骨髓炎伴大面积软组织缺损患者行Ilizarov骨搬移结合换药治疗的临床资料.患者均为GustilluⅢ型患者,C型损伤11例,皆合并血管损伤11例.4例伴有对侧肢体损伤.男10例,女4例;年龄21 ～ 45岁,平均35岁.受伤至手术时间12～24 d,平均19 d.首先进行感染部位清创,术后伤口开放,然后行Ilizarov骨搬运技术治疗骨缺损同时换药治疗.末次随访时采用Paley骨与功能评分方法评定疗效.结果 14例患者全部随访,随访时间24～36个月,平均27个月,修复骨缺损5～13 cm,平均7cm,骨搬移完成时间术后2～6个月,平均4月.皮肤在骨搬移过程中全部愈合.骨折全部愈合.感染治愈13例,1例转为慢性骨髓炎,治愈率为93％.末次随访时Paley骨折愈合评分.优11例,良2例,可1例,优良率为93％;Paley功能评分结果:优10例,良2例,可2例,优良率为86％.结论 换药结合Ilizarov骨搬移是治疗急性胫骨髓炎伴大面积软组织坏死的一种较安全、有效的方法.
目的 分析Ilizarov技術結閤換藥治療急性脛骨骨髓炎伴大麵積軟組織壞死的效果.方法 迴顧性分析2009年7月至2012年9月14例急性脛骨骨髓炎伴大麵積軟組織缺損患者行Ilizarov骨搬移結閤換藥治療的臨床資料.患者均為GustilluⅢ型患者,C型損傷11例,皆閤併血管損傷11例.4例伴有對側肢體損傷.男10例,女4例;年齡21 ～ 45歲,平均35歲.受傷至手術時間12～24 d,平均19 d.首先進行感染部位清創,術後傷口開放,然後行Ilizarov骨搬運技術治療骨缺損同時換藥治療.末次隨訪時採用Paley骨與功能評分方法評定療效.結果 14例患者全部隨訪,隨訪時間24～36箇月,平均27箇月,脩複骨缺損5～13 cm,平均7cm,骨搬移完成時間術後2～6箇月,平均4月.皮膚在骨搬移過程中全部愈閤.骨摺全部愈閤.感染治愈13例,1例轉為慢性骨髓炎,治愈率為93％.末次隨訪時Paley骨摺愈閤評分.優11例,良2例,可1例,優良率為93％;Paley功能評分結果:優10例,良2例,可2例,優良率為86％.結論 換藥結閤Ilizarov骨搬移是治療急性脛骨髓炎伴大麵積軟組織壞死的一種較安全、有效的方法.
목적 분석Ilizarov기술결합환약치료급성경골골수염반대면적연조직배사적효과.방법 회고성분석2009년7월지2012년9월14례급성경골골수염반대면적연조직결손환자행Ilizarov골반이결합환약치료적림상자료.환자균위GustilluⅢ형환자,C형손상11례,개합병혈관손상11례.4례반유대측지체손상.남10례,녀4례;년령21 ～ 45세,평균35세.수상지수술시간12～24 d,평균19 d.수선진행감염부위청창,술후상구개방,연후행Ilizarov골반운기술치료골결손동시환약치료.말차수방시채용Paley골여공능평분방법평정료효.결과 14례환자전부수방,수방시간24～36개월,평균27개월,수복골결손5～13 cm,평균7cm,골반이완성시간술후2～6개월,평균4월.피부재골반이과정중전부유합.골절전부유합.감염치유13례,1례전위만성골수염,치유솔위93％.말차수방시Paley골절유합평분.우11례,량2례,가1례,우량솔위93％;Paley공능평분결과:우10례,량2례,가2례,우량솔위86％.결론 환약결합Ilizarov골반이시치료급성경골수염반대면적연조직배사적일충교안전、유효적방법.
Objective To investigate the clinical efficacy of Ilizarov bone transport combined with dressing change in the treatment of acute tibial osteomyditis accompanied with massive soft tissue defection.Methods From July 2009 to september 2012, 14 patients with acute tibial osteomyelitis associsted with large-area soft tissue necrosis and defection were treated in Traumatic Orthopaedics Department of the Central Hospital of Binzhou.All cases were Gustillu Ⅲ type open fracture, and Ⅲ C type injury in 11 casas accompanied with vascular injure.Associated with contralateral lower limb in 4 casas.They were 10 male and 4 female,aged from 21 to 45 years old(average age of 35 years old).The duration from injury to surgery ranged from 12-24 days,averaging of 19 days.All cases were treated first with excision of the infected or necrosis bone segment and soft tissue.The wound keep opening, followed by llizarov bone transport combined with dressing change to repair the bone and soft tissue defection.The clinical efficacy was assessed using the Paley's evaluation system at the last follow-up.Results All the patients were followed up for 24 to 36 months (average of 27 months).The bone defection rapaired was from 5 to 1 3 cm(average of 7 cm).The mean duration of distraction was 4 months, range from 2 to 6 months.All cases' gain s.ufficient soft tissue coverage the later period of Ilizarov bone transport.All the fracture and bone defection were cured.Infection were cured in 13 cases, and 1 case converted to chronicle osteomyelitis, and the cure rate was 93％.According to the Paley' s system, the bone union was excellent in 11 cases, good in 2 cases, and fair in 1 Cases, with a good-to-excellent rate was 93％.The functional outcome was excellent in 10 cases,good in 2 cases,and fair in 2 cases,with a good-to-excellent rate of 86％.Conclusion Ilizarov bone transport and dressing change is one reliable and effective treatment of tibial acute infected and soft tissue defection.
