摘要
目的:探讨难治性骨不连与骨缺损外固定技术的治疗。方法:分别运用骨端一端加压、EECL或EBTL方法,采用半环槽式外固定器治疗85例难治性骨不连与骨缺损,并一期完成肢体延长。结果:85例难治性骨不连与骨缺损均获骨性愈合,并一期完成了肢体长度的重建,无严重并发症发生。结论:加压量为自身体重的1/2～1倍较适宜;术后1周内应每天在传感器的监测下将压力量调整至初始值;对单纯性骨不连仅需骨端一端加压即可;伴有患肢短缩的骨不连,骨缺损幅度小于骨原长度15%时,可安全采用EECL方法,骨缺损幅度为15～20%时,需在脉冲多谱勒血流测定仪监测下谨慎采用;若骨缺损幅度大于20%时则必须采用SBTL方法治疗。骨外固定是治疗感染性骨不连骨缺损的重要手段,在牢稳固定下,感染易于得到控制。
Objective:To investigate the value of external fixator in the treatment of bone defect and nonunion due to healing difficulty. Methods:A total of 85 patients were treated with different methods including end-to-end compression in simple nonunion, or end-to-end compression followed by lengthening (EECL), and segmental bone transport by lengthening(SBTL) in bony defect with the sulcated half-ring external fixator. Some patients suffering from infected nonunion with bone loss received the above operation after debridement. Results: All the patients with nonunion achieved union within 3—7 months. The bony healing of lengthening area was seen within 4—11 months and the limb shortening corrected in the same period of time. No disorder of the extremity circulation or nerve was found. Conclusion: The appropriate stress amount of compression is about 1/2 — 1 time of body weight of patient. The stress between bony ends should be regulated to the initial every day within 1 week postoperatively. The treatment of simple nonunion needs only end-to-end compression. However, in those patients with nonunion in combination with bony defect, EECL can be used if bony defect is less than 15% of the original length. SBTL might be the only feasible means if bony defect is more than 20% of the original length. EECL should be applied with great care along with constant monitoring of the circulation of the extremity with impulse Dopplar monitor if bony defect is within 15—20%. External fixator is an important method in the treatment of infected nonunions. It is suggested that active infection will become quiescent once the fixation is inherently stable.
出处
《感染．炎症．修复》
2001年第1期12-15,共4页
Infection Inflammation Repair
关键词
骨外固定
骨不连
骨缺损
骨延长
External fixation Bone nonunion Bone defect Bone lengthening
