摘要
目的 探讨Ilizarov技术骨搬移治疗胫骨骨不连及软组织缺损感染的临床疗效.方法 回顾性分析2009年10月～2013年2月采用Ilizarov技术行胫骨骨搬移治疗13例胫腓骨粉碎性骨折合并软组织缺损严重感染患者,均为胫腓骨开放性粉碎骨折合并软组织严重感染药,9例为软组织感染及缺损未超过骨折区远近端,4例为软组织感染及缺损超过骨折区远近端.截骨后＞6cm缺损采用环形外固定架搬移,＜6cm采用单向外固定架搬移.均一期行截骨搬移及创面清创VSD负压吸引术,术后1～2周（平均8天）开始搬移,每天搬移1mm,VSD术后2周均拆除,术后调整力线及搬移速度.结果 13例均获随访7～26个月,平均16.2个月.修复骨缺损4～9cm,平均6cm,术后3～5个月骨搬移已完成,外固定架平均于术后230天去除,皮肤均在骨搬移过程中自然愈合.愈合率100％.给予处理后坚持负重行走,半年后愈合.根据Paley骨性评分标准和功能评分标准,骨性结果为优7例,良3例,中3例,优良率76.9％.功能结果为优6例,良5例,可2例,优良率84.6％.结论 Ilizarov技术骨搬移治疗胫骨骨不连及软组织缺损感染可以起到一期手术、缩短治疗病程、避免皮瓣转移等优点,骨与软组织均愈合良好的疗效,是一种治疗该类疾患的有效方法.
Objective To explore clinical efficacy of Ilizarov technique bone transportion to treat tibial nonunion and soft tissue defect infection.Method Ilizarov technique bone transportion was used to treat 10 male and 3 female patients with tibial nonunion and soft tissue defect infection.The left side was affected in 6 cases and the right side in 2 cases.The cases of soft tissue defect infection zone were beyond the racture zone in 4 cases and were within the fracture zone in 9 cases.All cases were infection,with a bone fractures nonunion of 4-9cm.The average time from injury to bone transportion was 3.6 month.The osteotomy and bone lengthening,bone transport was started 1-2 weeks （average 8 days） after operation with a speed of 1mm/d and completed in 4 times.Simultaneously,the alignment was adjusted after operation.Results The 13 patients were followed up for 7 to 26 months after operation.The average bone lengthening in this series was 6cm.The external fixation time was 230 days.According to the modified Paley＇s criteria for bone healing,7 cases were excellent,3 were good and 3 were moderate.There were 6 cases with excellent functional recovery,5 with good functional recovery and 2 cases with moderate functional recovery.Conslnsion Ilizarov technique bone transportion can be used to treat patients with tibial nonunion and soft tissue defect infection at one stage.It can shorten the treatment cycle and avoid flap transferring shortcoming.
出处
《西部医学》
2014年第8期993-995,998,共4页
Medical Journal of West China
