摘要
目的探讨胫骨骨搬移后牵张成骨不良的X线分型和治疗方法。方法回顾性分析2012年1月至2018年12月治疗并有随访资料的胫骨骨搬移患者321例,其中42例(13.1%)X线片显示成骨不良;男27例,女15例;年龄4~65岁,平均33.1岁;成骨不良发生部位:胫骨近端26例,胫骨干3例,胫骨远端13例。胫骨缺损长度为3.5~21.7 cm,平均6.7 cm。胫骨骨搬移并发的牵张成骨不良根据X线表现可分为4种类型:纵向型缺损,横向型缺损,虫蚀型缺损,全长型缺损。治疗的主要流程为:全身评估、局部评估、调架刺激和手术干预。调架刺激方法包括减调、停调、回调、手风琴技术,手术干预主要为二处截骨和植骨。使用外固定指数评估牵张成骨愈合及矿化情况,以Paley骨搬移治疗骨缺损肢体功能评价系统评估肢体功能。结果42例患者均获得随访,随访时间(33.71±11.7)个月(范围24~72个月)。成骨不良分型:纵向型缺损25例(59.5%,25/42),横向型缺损8例(19.0%,8/42),虫蚀型缺损2例(4.8%,2/42),全长型缺损7例(16.7%,7/42)。经治疗后,除2例截肢外,其余40例成骨不良均愈合,恢复行走功能。40例外固定指数为1.55~2.83个月/cm,平均1.76个月/cm。Paley骨搬移治疗骨缺损肢体功能评价标准:优27例,良10例,可1例,差2例,优良率为92.5%(37/40)。治疗后再次出现的并发症包括:钉道感染(3例),骨搬移段轴向偏移(4例),马蹄足(2例),截肢(2例);并发症总发生率为26.2%(11/42);经对症处理后均纠正。结论根据X线表现,胫骨骨搬移中的截骨处成骨不良可分为纵向型缺损、横向型缺损、虫蚀型缺损、全长型缺损;按分型采用全身及局部对症治疗、调架刺激和手术干预,成骨不良的补救结果优良。
Objective To study the X-ray manifestations of distraction osteogenesis in tibial bone transfer,put for-ward the classification and formulate the standard treatment protocols.Methods Data of 42 cases among 321 cases with dysplasia of distraction osteogenesis who had tibial bone transfer from January 2012 to December 2018 were retrospectively analyzed.There were 27 males and 15 females aged from 4-65 years old,with an average of 33.1 years.The dysplasia sites were 26 cases of proximal tibia,3 cases of tibial shaft and 13 cases of distal tibia.The length of tibial defect ranged from 3.5 cm to 21.7 cm,with an average of 6.7 cm.The main management protocol included systemic assessment,local assessment,fixator adjusting stimulation and surgical intervention.The fixator adjusting stimulation included transport slowing,transport stopping,transport backing,and accordion techniques.The main surgical intervention was second site osteotomy and bone grafting.According to the X-films,the dysplasia of the tibia transport can be divided into four types:longitudinal defect;transverse defect;insect erosion defect;full-length defect.External fixation index(EFI)was used to evaluate the healing and mineralization of distraction osteogenesis.The limb function was evaluated by Paley method.Results All 42 cases were followed up for 33.71±11.7 months(range,24-72 months).The types of dysplasia were as follows:25 cases(59.5%)of longitudinal defects,8 cases(19.0%)of transverse defect,2 cases(4.8%)of insect erosion defect,and 7 cases(16.7%)of full-length defects.After the treatment,except for 2 cases of amputation,all the dysplasia healed and the patients recovered limb walking.External fixation index of 40 cases was 1.55-2.83 months/cm,with an average of 1.76 months/cm.According to Paley evaluation method,27 cases were excellent,10 cases good,1 case fair,and 2 cases poor,thus the excellent and good rate was 92.5%(37/40).The complications after treatment included:nail tract infection(3 cases),axial displacement of transferred segment(4 cas
作者
朱跃良
徐永清
Zhu Yueliang;Xu Yongqing(Department of Orthopaedic Surgery,920th Hospital of Joint Logistics Support Force of PLA,Kunming 650032,China;Department of Orthopaedic Surgery,2nd Affiliated Hospital,School of Medicine,Zhejiang University)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2021年第11期669-676,共8页
Chinese Journal of Orthopaedics
基金
云南省创伤骨科临床医学中心项目(ZX20191001)。
关键词
胫骨
伊利扎罗夫技术
骨生成
牵张
Tibia
Ilizarov technique
Osteogenesis,distraction
