摘要
目的 探讨Ilizarov技术改善骨搬运中轴向偏移的角度、发生率及效果。方法 回顾分析2010年1月-2014年12月采用Ilizarov骨搬运技术治疗的14例胫骨骨折患者临床资料。男11例,女3例;年龄18~70岁,平均38.8岁。感染性骨缺损10例,非感染性骨缺损4例。根据Paley等提出的骨缺损分型：B1型（不合并短缩的骨缺损）7例,B3型（合并短缩的骨缺损）7例。受伤至手术时间1~72个月,平均11.9个月。采用外固定支架构型和调整固定骨搬运段半针与全环的距离,改变四边形边角关系,调整骨搬运段与对合端骨段的对合关系及对合端两骨段的力线,使患肢力线达到满意程度,以纠正轴向偏移。结果 术后患者均获随访,随访时间9~31个月,平均19.1个月。术后4例患者骨对合端自然愈合,余10例经植骨处理后愈合。术后1周初次复查X线片,发生冠状位成角10例（3~12°,平均4.9°）,矢状位成角9例（2~12°,平均3.8°）;轴向偏移6例（43%）,通过矫正,5例轴向偏移明显纠正,1例因患者依从性差错失调整搬移环半针的最佳时机,末次随访时仍有6°力线偏差。末次随访时冠状位成角5例（2~4°,平均1.1°）,矢状位成角6例（2~6°,平均1.6°）,轴向偏移1例（7%）,均较术后初次复查时显著改善。末次随访时根据Paley等提出的评价标准,骨性结果优12例、良2例,功能结果优12例、良2例。结论 Ilizarov骨搬运技术通过安装骨搬运段外固定支架构型,术后搬运过程中逐渐调整半针与搬移环间的距离,可以改善骨对合端轴向偏移发生。
Objective To explore the effectiveness of Ilizarov technique in improving bone transport axial offset. Methods Between January 2010 and December 2014, 14 patients with tibial fracture were treated by using Ilizarov technique. Of 14 cases, 11 were male and 3 were female, aged 18-70 years （mean, 38.8 years）; there were 10 cases of infective bone defect and 4 cases of non-infective bone defect. According to Paley typing, 7 cases were rated as type B1 （bone defect without shortening） and 7 cases as type B3 （bone defect with shortening）. The injury to operation time was 1 to 72 months （mean, 11.9 months）. Ilizarov fixation was used for type architecture and adjusting fixed bone removal of half the distance between the needle and the ring, changing the auadrilateral edges, adjusting the convolution relationship between the bone removal section and bone segment involution, and adjusting the two force lines of bone segment involution end so as to make the limb lines of force satisfactory. Results The patients were followed up 9-31 months （mean, 19.1 months）. Four cases achieved natural bone healing at last followlup, bone healing was obtained in 10 cases after bone graft. At 1 week after operation, X-ray films showed angulation in the coronal plane in 10 cases （3-12°, 4.9° on average） and in the sagittal plane in 9 cases （2-12°, 3.8° on average）; axial offset was observed in 6 cases （43%）, which was corrected in 5 cases except 1 case. At last follow- up, angulation in the coronal plane was observed in 5 cases （2-4°, 2.6° on average）, angulation in the sagittal plane in 6 cases （2-6°, 4.1° on average）, and axial offset in 1 case （7%）, which were significantly improved when compared with ones at 1 week. According to Paley evaluation criteria, the osseous results were excellent in 12 cases and good in 2 cases; the functional results were excellent in 12 cases and good in 2 cases at last follow-up. Conclusion Axial offset in the Ilizarov bone transport relatively common. By
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2016年第5期546-550,共5页
Chinese Journal of Reparative and Reconstructive Surgery
