摘要
目的分析骨搬移治疗胫骨感染性骨不连的临床疗效。方法2002年10月至2007年10月采用胫骨感染骨端清创、重建外固定支架加压固定及胫骨干骺端截骨骨搬移治疗胫骨感染性骨不连、纠正肢体短缩畸形45例。结果45例胫骨感染均得到一期控制，软组织缺损创面消灭，4例出现钉道感染；44例骨折愈合，1例骨折端再次形成骨不连；39例双下肢长度基本恢复一致，6例仍有1．5～3cm肢体短缩畸形存在，1例因截骨端提前愈合使肢体未能达到预期长度；术后截骨端骨延长2～9cm，平均延长6cm，无血管及神经损伤的症状出现；术后外固定支架固定6～12个月，平均8个月，所有病例延长区新骨组织形成良好。结论采用骨搬移治疗胫骨感染性骨不连，能达到一次手术兼顾控制骨端感染、消灭皮肤创面、骨折端不需植骨达到骨性愈合及均衡肢体长度的临床治疗作用，是治疗胫骨感染性骨不连的理想方法。
Objective To study the clinical outcomes of treating infected tibial nonunion using bone transport technique. Methods From October 2002 to October 2007,totally 45 patients（27 males,18 females） suffering from infected tibial nonunion were treated by radical debridement ,compression and fixation of bone defect and shortening site with Orthofix LRS. Corticotomy was carried out in the tibial metaphysis combined with bone transport. The mean age of the patients was 38 years （range 10-55 years）. 22 patients were injured in road accidents, 15 patients fell from high,and 8 patients were crashed by heavy things. The mean time from the injure to the operation was 14 months （range 6-21 years）. Patients＇were underwent 2 to 7 operations,the average was 4.5.35 patients had bone defect and shortening ,the mean shortening was 4.2 cm（range 2-8 cm）. 38 patients had cutaneous deficiency and bone revealed. Results All 45 patients got primary infection controlled,raw surface of soft tissue deficiency eliminated. One patient was bone nonunion again. One was bone union at the osteoeetomy site ahead of achieving the prospective length. 4 patients occurred pin track infection. None had the symptoms of the blood vessel and the nerve injury. The mean length of regenerating bone were 6 cm（range 2-9 cm）. 39 patients almost obtained the same length of the two lower extremities, but 6 still had shortening of 1. 5- 3 cm. The mean time of fixation period was 8 months （range 6-12 months）. All patients got fine newly formed bone at the distraction site to achieve bone union. Conclusion The infected tibial nonunion can be successfully treated using the orthofix LRS external fixtor combined with internal bone transport technique. The infection control,raw surface eliminate and large bone defects can be treated on one operation with no bone grafting.
出处
《实用骨科杂志》
2009年第3期180-182,共3页
Journal of Practical Orthopaedics
关键词
骨折
感染性骨不连
外固定支架
骨搬移
fractures
infected nonunion
external fixators
bone transport
