摘要
目的 探讨下肢创伤后缺损性骨不连的术式选择。方法 回顾总结 1 990年 1月～ 2 0 0 2年 1月收治的 1 2 8例下肢长骨缺损性骨不连 ,按其缺损程度、软组织情况及有否感染分为Ⅲ度二型。Ⅰ度一型 :单纯部分皮质缺损 ,自体髂骨移植 ,钢板或髓内针固定 ;Ⅱ度一型 :≥ 1 5cm而 <5 0cm的单纯段状骨缺损 ,以半片腓骨、迭合髂骨、髓内植骨加梯形钢板或迭合髂骨闭锁髓内针固定 ;二型 ,即伴有软组织缺损或骨感染者 ,外固定架断端固定 ,骨延长术 ;Ⅲ度 :骨缺损≥ 5cm ,无论一型或二型 ,应用Ilizarov骨段输送技术。结果 全组病例均获骨性愈合 ,其中Ⅰ度 75例 ,术后 2例发生深部感染 ,1例畸形愈合 ,2例作了补充植骨 ;Ⅱ度 4 3例 ,2例螺丝钉松动 ,再次手术愈合 ,1例髓内植骨折断 ,4例遗有≤ 1 5cm短缩 ;Ⅲ度 1 3例 ,其中 2例作了缺损处的软组织修整或补充植骨。结论 下肢缺损性骨不连的分型治疗有利于术者选择简便、有效、患者痛苦小 。
Objective To try to find out a technique for bone defected ununion after lower limb trauma.Methods To review 128 patients with lower limb long bone defected bone ununion.According to their defected status,condition of soft tissue and infection,they have been divided into three degrees and two classifications.Class Ⅰ in Degree I:simple part cortex defected,self ilium grafted,plate or intramedullary nail fixed for them;Degree Ⅱ:≥1 5 cm and<5 0 cm simple segment bone defected,semi fibula inserted into the ilium intramedullary nailling with T shaped plate fixation or closed intramedullary nail fixed have been done for it.Class Ⅱ:bone defected with soft tissue defected or bone infection,external fixation devide fixed for them.Degree Ⅲ:≥5 cm bone defected,no matter class Ⅰor class Ⅱ,Ilizarov bone segment transfer technique should be used.Results All the patients have gotten bone union.Seventy five with Degree Ⅰ,2 of them had deep infection,1 had malunion,complement bone grafted have been done for 2.Forty three with Degree Ⅱ,2 of them had untight screw and another operation have been done for them,and their bone unioned finally,1 had inter marrow bone graft fracture,4 had≤1 5 cm shortened.In Degree Ⅲ,there were 13 patients,soft tissue fitting or complement bone grafted haven been done on defect area for 2.Conclusion Classification treatment for lower limb bone defected ununion is good for surgeon to chose a simple and effective method,it can decrease their patients pain and can decrease complications.
出处
《骨与关节损伤杂志》
2004年第2期96-98,共3页
The Journal of Bone and Joint Injury
