一期骨短缩与二期骨延长术治疗感染性胫骨骨缺损

目的探讨一期骨短缩与二期骨延长术治疗感染性胫骨骨缺损的临床疗效。方法回顾性分析自2008-07—2018-12采用一期骨短缩、二期Ilizarov骨延长术治疗的30例感染性胫骨骨缺损。观察术后伤口愈合、骨愈合、下肢功能恢复和并发症情况。骨愈合与下肢功能恢复情况按照Ilizarov技术研究与应用学会标准进行评价。结果 30例均获得随访,随访时间平均18.5(12～30)个月。术后伤口愈合良好,无感染复发。短缩骨愈合时间6～8个月,平均7.3个月;延长段骨愈合时间6～11个月,平均7.7个月;愈合指数为1.5～1.7个月,平均1.6个月。骨愈合分级:优21例,良7例,可1例,差1例。下肢功能恢复分级:优14例,良13例,可2例,差1例。并发症情况:针道感染4例,邻近关节挛缩或僵硬3例,足下垂2例,骨不愈合1例,暂时性腓总神经损伤1例,针道松动1例。结论在严格控制伤口感染的前提下,一期骨短缩、二期Ilizarov骨延长技术治疗感染性胫骨骨缺损可同时修复皮肤软组织缺损和胫骨缺损,具有简化伤口闭合、促进缺损骨愈合、骨愈合率较高、骨整体愈合时间短、并发症相对较少、肢体功能恢复满意等优点。     

Ilizarov技术同期治疗感染性胫骨大段缺损并小腿软组织缺损

目的探讨Ilizarov技术同期治疗感染性胫骨大段骨缺损并小腿软组织缺损的疗效。方法回顾性分析2012-01—2014-05应用Ilizarov技术同期治疗8例感染性胫骨骨缺损并软组织缺损。均为胫骨骨折术后感染,清创后小腿软组织缺损位于胫前内外侧,面积平均为30.4(24~91)cm2,胫骨缺损长度平均为9.5(6~13)cm。7例胫骨中远段缺损采用胫骨结节下方截骨向远端骨搬运修复,1例胫骨近段缺损采用胫骨远端截骨向近端骨搬运修复,软组织缺损修剪成椭圆形后直接拉拢缝合。术后10 d开始骨段搬运,速度为1 mm/d,分4次完成。结果术后延长段切口及创面均一期愈合。所有患者均获随访17~36个月,平均23个月。延长段骨自然愈合,愈合时间为210~496 d,平均271 d;愈合指数3.4~4.0 d/mm,平均3.7 d/mm。对接点2例行二期植骨后愈合,其余6例均自然愈合,愈合时间170~308 d,平均236 d。去除外固定架后5个月疗效根据ASAMI评价标准评定:优6例,良2例。结论Ilizarov技术简便、疗效良好,是同期修复感染后大段胫骨缺损并软组织缺损的可靠方法。     

一期短缩二期延长治疗下肢GustiloⅢC型开放性骨折的疗效分析

目的探讨一期短缩二期延长治疗下肢GustiloⅢC型开放性骨折的疗效。方法回顾性分析武汉市第四医院骨科2010年1月至2018年1月急诊收治的12例下肢GustiloⅢC型开放性骨折的患者资料,男8例,女4例;年龄22~67岁,平均41.2岁。所有患者均伴有骨与皮肤软组织缺损,合并下肢神经、血管损伤。软组织缺损面积4 cm×2 cm~17 cm×12 cm;主干血管清创后短缩1.2~8.3 cm,平均4.2 cm;神经断端清创后短缩1.0~8.1 cm,平均4.0 cm;胫骨干缺损长度2.0~9.6 cm,平均6.3 cm。所有患者均急诊一期彻底清创,骨折处短缩外固定支架固定行骨搬运。记录骨延长牵张速度、带架时间及并发症情况,末次随访时根据Paley评分标准评定下肢功能。结果12例患者术后获14~32个月(平均19.1个月)随访,12例患者肢体均存活且未发生严重感染。12例患者肢体短缩长度2.0~8.2 cm(平均3.6 cm)。骨搬运速度平均0.87 mm/d;带架时间11~16个月(平均13.2个月)。所有患者骨愈合时间10~14个月(平均11.2个月)。7例患者术后马蹄内翻畸形,2例出现Dahl分级3级以下的针道感染。末次随访时根据Paley评分标准评定下肢功能:优8例,良3例,可1例。结论一期短缩二期利用外固定技术行肢体延长及骨搬运治疗,降低了下肢GustiloⅢC型开放性骨折的保肢风险及手术难度,临床效果良好。     

短缩-延长肢体治疗胫骨骨缺损合并软组织缺损

目的探索单纯使用Orthofix重建外固定架通过短缩一延长肢体治疗胫骨骨缺损合并软组织缺损的可行性。方法2001年7月～2006年7月收治胫骨骨缺损合并软组织缺损患者39例，其中37例为胫骨感染性骨折不愈合，2例为胫骨开放性骨折（GustiloⅢB型1例，Gustilo ⅢC型1例）。在患肢上安放Orthofix重建外固定架。清创术后小腿胫前内侧软组织平均缺损12cm（6～24cm），胫骨骨缺损平均9cm（4～22cm）。对胫骨骨缺损〈5cm的患者使用一期清创．腓骨截骨．胫骨缺损端加压。对22例胫骨缺损〉5cm的患者采用清创，腓骨截骨．短缩肢体〈5cm。对炎症局限、胫骨截骨部皮肤正常而且远离伤口的患者同期行胫骨截骨术，否则于1．0～1．5个月后二期行胫骨截骨术延长恢复肢体的长度。结果所有患者平均随访14个月（10～44个月）。骨缺损均得以重建，患肢肢体长度与健侧之差小于5mm，骨折愈合，无感染复发，创面均闭合。1例术后出现腓总神经麻痹，术后2个月恢复。4例胫骨缺损患者诉膝部疼痛。5例胫骨蠓损患者出现马蹄内翻足。2例胫骨缺损出现下胫腓分离。1例再骨折。结论使用Orthofix重建外固定架进行短缩．延长肢体是治疗胫骨骨缺损合并软组织缺损的有效方法，但应谨慎使用。对于软组织缺损少的小腿一期短缩的安全限度为3cm，最终短缩6cm。对于软组织缺损较大的急性胫骨开放骨折小腿一期可以短缩9cm。     

Ilizarov外固定架骨搬移技术联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露的疗效分析

[目的]探讨和总结Ilizarov外固定架骨搬移技术联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露的手术方法及其疗效。[方法]本科2011年10月~2013年12月应用Ilizarov环形外固定架联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露患者16例;小腿软组织缺损范围(4.0~6.0)cm×(3.0~4.5)cm,胫骨骨缺损长度4.5~8.0 cm,平均6 cm。先清创取出死骨块、VSD技术覆盖创面控制感染,再用Ilizarov骨搬移技术使骨缺损修复,骨折愈合。参照Paley评价标准进行功能评价,并分析其骨折愈合时间、带外固定架时间、术后患肢功能恢复情况。[结果]所有病例均获得随访,随访时间9~24个月,平均10.5个月。其中11例应用皮瓣转移覆盖创面修复,3例通过游离皮片移植创面愈合,2例经换药愈合,软组织修复良好。使用VSD 3~6期,平均4.8期;带外固定架时间6~18个月,平均10.3个月;骨段搬移延长4.5~8.0 cm,平均6 cm;骨折愈合时间6~15个月,平均9.8个月。根据Paley骨折愈合与功能分级评价骨搬移结果及功能,优9例,良5例,可2例。[结论]Ilizarov外固定架骨搬移技术联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露具有操作简便、疗效肯定、并发症发生率低、可随时调整纠正畸形等优点,值得推广。     

组织瓣移植联合骨延长技术分期修复烧创伤后下肢严重软组织与骨缺损

目的探讨组织瓣移植联合骨延长技术修复烧创伤后下肢严重软组织与骨缺损的临床效果。方法2010年1月—2015年12月,收治严重股骨或胫骨合并皮肤软组织缺损患者11例。男10例,女1例;年龄19~37岁,平均28岁。致伤原因:交通事故伤8例,高压电烧伤2例,CO中毒烧伤1例。伤后至该次入院时间为3~14 d,平均6.5 d。骨缺损长度8~18 cm,平均14 cm;皮肤软组织缺损范围13 cm×8 cm~25 cm×19 cm。一期彻底去除坏死组织和病变股骨或胫骨断端,组织瓣修复软组织缺损;二期采用Orthofix单边外固定延长架或Ilizarov环形外固定延长架修复骨缺损。结果术后1例修复术后2个月皮瓣下出现一窦道,经扩创、去除坏死股骨、抗生素骨水泥间隔物填充后愈合;其余患者切口均Ⅰ期愈合。骨延长期间,1例出现针道感染,经换药和加强护理后控制感染。患者截骨段延长8~18 cm,平均14 cm;停止延长后外固定支架继续保留4~12个月,平均6.5个月。患者骨缺损均修复,骨愈合时间为12~22个月,平均17个月。患者均获随访,随访时间8~24个月,平均15个月。患者治疗期间均未出现血管、神经损伤,术后未见骨髓炎、再骨折等并发症发生,下肢功能恢复较好。结论组织瓣移植联合骨延长技术修复烧创伤后下肢严重软组织与骨缺损可获较好疗效。     

成人胫骨缺损新分型与骨搬移治疗策略:附58例报告

背景:胫骨缺损常合并软组织损伤、肢体畸形、不等长等问题。目前的临床分型并不能涵盖一些复杂胫骨缺损情况。目的:从Ilizarov骨搬移技术角度探讨成人非感染性胫骨缺损临床新分型及治疗策略。方法:分析2000年4月至2017年1月应用Ilizarov骨搬移技术治疗的58例成人无感染性胫骨缺损。依据胫骨缺损的长度、部位、是否合并畸形以及相应的Ilizarov骨搬移手段分为5个类型。Ⅰ型:1 cm<中下/上段骨缺损≤6 cm,无明显成角畸形。采用胫骨单节段截骨,向缺损端搬移。Ⅱ型:6 cm<中下/上段骨缺损≤10 cm,无明显成角畸形。采用双节段截骨同步向缺损端骨搬移。Ⅲ型:6 cm<中段骨缺损≤10 cm,无明显成角畸形,胫骨上、下双节段截骨,向心性骨搬移。Ⅳ型:6 cm<上、下两段缺损≤10 cm,中段残留活骨≥6 cm,无明显成角畸形。将胫骨中间残留的一段活骨2处截骨,成为3块骨,中间骨块固定作为两块骨搬移再生的"母骨"支点,上下两段骨块反向分离牵拉,一期修复上下2区骨缺损。Ⅴ型:胫骨缺损>10 cm,合并骨干>7°成角畸形。采用腓骨上下两处截骨,先纵向牵拉使胫骨缺损间隙加大、成角畸形矫正,再横向牵拉将腓骨中间段搬移至胫骨缺损处,使其腓骨胫骨化。观察5个临床分型组骨缺损修复骨愈合、畸形矫正、有无肢体短缩等并发症、汇合端愈合情况等。拆除外固定后随访,采用改良Paley骨不连评价标准进行评价。结果:55例患者获得随访,随访时间24~104个月,平均(32.0±21.4)个月。所有患者均实现骨缺损修复并最终骨性愈合,骨愈合指数35~60d/cm,平均(49.0±6.4)d/cm。1例Ⅳ型,4例Ⅴ型患者术后肢体短缩>2.5 cm(2.7~3.5 cm)。末次随访无>7°局部畸形病例。未发生1例深部感染、血管神经损伤等并发症。17例因汇合端骨愈合迟缓,二次手术取自体髂骨植骨。带外固定架时间5~28个月。治疗效果:优41例、良11例、可3例,优良率94.5%(52/55)。结论:成人胫骨缺损新分型既有利于病情评估亦利于制定合理的治疗方案。针对不同类型制定的个体化骨搬移重建方法,可一期手术修复骨缺损、矫正畸形、延长肢体,临床疗效显著,值得推广。     

骨搬移治疗胫骨感染、骨缺损及软组织缺损

目的分析骨搬移治疗胫骨感染、缺损及软组织缺损的临床疗效。方法采用胫骨感染骨端清创、重建延长器外固定架及胫骨干骺端截骨骨搬移治疗胫骨感染、缺损及软组织缺损7例。结果 1例出现钉道感染,7例骨折均愈合,术后截骨端骨延长3.5~8.5 cm,平均4.5 cm,无血管和神经损伤的症状。结论采用Ilizarov骨搬移技术治疗胫骨感染、骨缺损及软组织缺损,可以一次性解决骨端感染、消灭皮肤缺损,且骨折断端不需要植骨即可达到骨性愈合。     

Ilizarov骨滑移技术治疗四肢长骨创伤性骨髓炎的临床研究

[目的]探讨应用Ilizarov技术治疗四肢长骨创伤性骨髓炎的临床疗效。[方法]2009年4月~2013年5月应用Ilizarov技术治疗四肢长骨创伤性骨髓炎患者15例。男11例,女4例;年龄15~62岁,平均39.5岁,病程为5~32个月,平均17.2个月。其中肱骨2例,股骨2例,胫骨11例。骨缺损范围3.2~12.9 cm,平均7.6 cm。采用病灶骨段切除、Ilizarov技术骨段延长结合清创、灌洗引流、开放换药及VSD技术等治疗。观察外固定时间、骨性愈合时间、术后患肢延长长度及肢体功能恢复情况。术后按Paley评价标准进行功能评价,并应用Spearman秩检验分析其相关性。[结果]15例患者随访6~28个月,平均16.4个月。15例患者均获得了良好的骨性愈合,患肢延长长度平均为7.6 cm。外固定时间6.2~12.5个月,平均7.4个月。平均外固定指数为36.8 d/cm(25.2~75.6 d/cm);骨搬运速度为15.7 d/cm(12.3~23.8 d/cm)。根据Paley治疗感染性骨不连改良评分标准评定功能结果:优13例,良2例,优秀率达86.7%。延长长度与骨愈合、功能恢复等级均呈负相关(P0.05);外固定时间与功能恢复呈负相关(P0.05)。[结论]治疗创伤性骨髓炎的关键在于解决感染、皮肤软组织缺损和骨缺损、骨不连问题,而Ilizarov骨滑移技术不仅可安全有效控制感染、修复软组织及骨缺损,而且利用时间因素在三维空间逐渐牵拉刺激组织生长及塑形,纠正畸形,避免多次手术,且临床疗效优良,治疗过程较为简单,值得临床推广应用。     

Ilizarov技术一期短缩延长术治疗感染性大段骨缺损

[目的]探讨应用Ilizarov技术一期短缩延长术治疗感染性大段骨缺损的方法及临床疗效。[方法]2000~2013年13年间,应用Ilizarov技术一期短缩延长术治疗下肢大段感染性骨缺损60例。男42例,女18例;治疗时年龄:最小6岁,最大52岁,平均34岁。股骨20例,胫骨40例,合并足下垂30例。骨缺损长度7~9 cm 16例,9~12 cm 18例,12 cm以上26例,最长缺损25 cm。治疗时仍有感染的42例,股骨15例,胫骨27例;感染静止18例。治疗过程:彻底切除感染病灶,从切除骨端清除髓腔内炎症肉芽组织,骨髓腔内及残存髓腔内放置川嶌式持续洗净管,生理盐水加敏感抗生素洗净,安装Ilizarov环形外固定架,一期尽可能加压短缩使两断端接合;如缺损范围过长或软组织臃肿,一期不能完成加压短缩对接,术后缓慢加压短缩,直到两断端对接。骨干骺端皮质骨截骨,截骨后2周开始延长,每日延长0.5~1 mm,分4~6次进行,直到两下肢等长。对接点部分骨缺损,股骨12例,胫骨26例,经再次补充植骨16例,碎骨术8例,骨断端愈合及延长段骨皮质化完成后,拆除外固定。[结果]炎症全部治愈。股骨20例全部对接点愈合,两下肢等长;13例膝关节僵硬,7例能部分屈伸,1例合并髋内翻。胫骨40例,38例两下肢等长,2例下肢短缩1 cm,自感满意。足下垂30例同时矫正27例,2例部分矫正,1例出院时尚未矫正。[结论]Ilizarov技术一期短缩延长术是治疗大段感染性骨缺损肯定有效的方法,值得普及推广。     

Ilizarov bone transport using an intramedullary cable transportation system in the treatment of tibial bone defects

IntroductionSegmental tibia defects remain challenging for orthopedic surgeons to treat. The aim of this study was to demonstrate bone-related and functional outcomes after treatment of complex tibial bone defects using Ilizarov bone transport with a modified intramedullary cable transportation system (CTS).Patients and MethodsWe conducted a single-center, retrospective study including all 42 patients treated for tibial bone loss via Ilizarov bone transport with CTS between 2005 and 2018. Bone-related and functional results were evaluated according to the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system. Complication and failure rates were determined by the patients’ medical files.ResultsPatients had a mean age of 45.5 ± 15.1 years. The mean bone defect size was 7.7 ± 3.4 cm, the average nonunion scoring system (NUSS) score was 59 ± 9.5 points, and the mean follow-up was 40.8 ± 24.4 months (range, 13-139 months). Complete bone and soft tissue healing occurred in 32/42 patients (76.2%). These patients had excellent (10), good (17), fair (2), and poor (3) results based on the ASAMI functional score. Regarding bone stock, 19 patients had excellent, 10 good, and 3 fair results. In total, 37 minor complications and 62 major complications occurred during the study. In 7 patients, bone and soft tissue healing occurred after CTS failure with either an induced membrane technique or classic bone transport; 3 patients underwent lower leg amputation. Patients with treatment failure were significantly older (57.6 vs. 41.8 years; p = 0.003). Charlson score and treatment failure had a positive correlation (Spearman's rho 0.43; p = 0.004).ConclusionBone transport using both intramedullary CTS and Ilizarov ring fixation is viable for treating patients with bone loss of the tibia and complex infection or soft tissue conditions. However, a high number of complications and surgical revisions are associated with the treatment of this severe clinical entity and should be taken into account.     

膜诱导技术治疗肢体肿瘤切除后骨干缺损的初期疗效分析

目的 探讨应用Masquelet膜诱导技术治疗肢体肿瘤切除后长节段骨缺损的疗效。方法 回顾性分析2014年12月至2018年12月我院应用膜诱导技术治疗的5例骨肿瘤病人的临床资料,其中男4例,女1例,年龄为15~60岁,平均为35.8岁。病人均实施序贯性治疗方案：第1阶段彻底切除肿瘤的基础上,内固定稳定骨端和置入骨水泥间隔物;第2阶段,去除间隔物,在诱导膜内植入自体松质骨修复骨缺损。采用Ilizarov方法研究与应用协会（Association for the Study and Application of the Method of Ilizarov, ASAMI）评价标准评价综合疗效,美国肌肉骨骼肿瘤学会（Musculoskeletal Tumor Society, MSTS）评分系统评价病人功能恢复情况。结果 病人骨缺损长度为8.5~11.0 cm,平均为9.5 cm。5例病人术后获10~34个月的随访,平均为15.4个月,无局部复发,无感染发生。骨愈合时间为第二阶段后4.2~11.0个月,平均为6.4个月。ASAMI评定标准均为优秀,MSTS评分平均为27.4分（25~29分）。1例出现骨质部分吸收,成骨菲薄,但功能正常。结论 Masquelet膜诱导技术治疗肿瘤切除后节段性骨缺损,是一种安全、简便、可靠的方法。     

手风琴技术用于骨搬移治疗胫骨骨缺损

目的 :分析Ilizarov技术治疗胫骨大段骨缺损时加用"手风琴技术"的临床治疗效果。方法 :2014年1月至2016年6月采用Ilizarov骨搬移技术治疗胫骨大段骨缺损患者22例,男19例,女3例;年龄23~60岁,平均44.04岁;骨搬移前骨缺损长度5~11 cm,平均7.68 cm;14例交通事故,3例摔伤,4例砸伤,1例高处跌落;左侧6例、右侧16例。分成两组,手风琴组搬移结束后实施手风琴技术11例,对照组搬移结束后外架锁定等待矿化11例。两组患者均获得随访,随访时间18~36个月,平均27.9个月。两组患者性别、年龄、骨缺损的长度比较,差异均无统计学意义(P0.05)。分析愈合时间、愈合指数等指标,并采用Paley等方法评价骨愈合和患肢功能恢复的治疗效果。结果:两组X线评价均达到骨性愈合;手风琴组:骨愈合时间(365±91)d,愈合指数(46.2±3.5)d/cm;对照组:愈合时间(435±108)d,愈合指数(57.8±3.5)d/cm;两组骨愈合时间比较,差异无统计学意义(t=1.648:P=0.115);两组骨愈合指数比较,差异有统计学意义(t=7.754,P=0.000)。末次随访时依据Paley评价标准评价疗效:实验组优9例,良2例;对照组优8例,良3例;两组比较差异无统计学意义(Z=-0.479,P=0.619)。并发症:钉道感染:手风琴组9例,对照组10例;局部牵拉痛:手风琴组2例,对照组1例;轴向偏移10°:手风琴组4例,对照组3例;骨缺损汇合端对位差:手风琴组3例;对照组2例;两组并发症比较差异无统计学意义(P0.05)。结论 :Ilizarov骨搬移技术治疗胫骨骨缺损时加用"手风琴技术"操作后可缩短治疗时间和矿化时间,提高愈合指数。     

Ten year experience with use of Ilizarov bone transport for tibial defects

Tibial defects greater than 4 cm and secondary to high-energy trauma or debridement for infected nonunion pose a significant challenge to the treating orthopaedic surgeon. Twelve patients who had been treated with Ilizarov bone transport for tibial defects over the past ten years were retrospectively reviewed. All patients were male with an average age of thirty-two. Ten of the twelve limbs were categorized as Grade IIIB fractures initially. The average tibial defect at initiation of bone transport was 9.45 cm (range 4 to 20 cm). The mean external fixator time (EFT) was 16.7 months with a mean external fixator index (EFI) of 2.0 months per centimeter. There were a total of 36 complications. Twenty were minor, fourteen were major without sequelae and two were major with sequelae. Overall bone results were good or excellent in nine patients. Overall functional results were good or excellent in eight patients. Ten patients achieved union after Ilizarov bone transport. Use of Ilizarov bone transport can be an effective tool for treating large tibial defects. However, the treatment time is lengthy with a considerable risk of complications.     

Ilizarov technique: Bone transport versus bone shortening-lengthening for tibial bone and soft-tissue defects

Objective

To compare the outcomes of bone transport and bone shortening-lengthening by Ilizarov technique for treatment of tibial bone and soft-tissue defects.

Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis

ObjectiveThis study was to compare the effectiveness of Masquelet technique versus Ilizarov bone transport in the treatment of lower extremity bone defects following posttraumatic osteomyelitis.Patients and methodsWe retrospectively reviewed 39 patients who had been treated at our department for lower extremity bone defects following posttraumatic osteomyelitis. They were 30 males and 9 females with a mean age of 39.18 (range, 12–63 years). The infected bone defects involved 26 tibias and 13 femurs. The mean length of the bone defects after radical debridement was 6.76 cm (range, 2.7–15.7 cm). Masquelet technique (MT, group A) was used in 20 patients and Ilizarov bone transport (IBT, group B) in 19 ones. The measurements were bone outcomes (union, deformity, infection and leg-length discrepancy) and functional outcomes (significant limping, joint contracture, soft tissue dystrophy, pain and inactivity).ResultsThe mean follow-up after removal of the apparatus was 25.26 months (range, 14–51 months). The mean finite fixator time was 10.15 months (range, 8–14 months) in group A versus 17.21 months (range, 11–24 months) in group B. The bone outcomes were similar between groups A and B [excellent (5 vs. 7), good (10 vs.9), fair (4 vs. 2) and poor (1 vs. 1)]; group A showed better functional outcomes than group B [excellent (8 vs. 3), good (9 vs. 6), fair (3 vs. 8) and poor (0 vs. 2)].ConclusionsIn the treatment of segmental lower extremity bone defects following posttraumatic osteomyelitis, both IBT and MT can lead to satisfactory bone results while MT had better functional results, especially in femoral cases. IBT should be preferred in cases of limb deformity and MT may be a better choice in cases of periarticular bone defects.     

开放性胫腓骨骨折合并胫骨骨缺损的手术治疗

目的探讨开放性胫腓骨骨折伴有大段骨缺损的手术治疗方法。方法自2003—09-2012—04对51例开放性胫腓骨骨折伴骨缺损者根据骨缺损长度进行分组,其中24例一期行外固定架结合腓骨钢板固定骨折端,二期骨缺损处行髂骨植骨;27例一期行Ihzamv骨搬移技术治疗胫骨大段骨缺损。结果骨缺损均得以重建,患者肢体长度完全恢复,患者肢体长度与健侧之差均〈2cm,无一例出现畸形,皮肤软组织得到修复。结论外固定架结合钢板固定是治疗合并胫骨骨缺损的开放性胫腓骨骨折的有效方法,骨缺损6em以内患者肢体功能及长度得以重建。IHzamv骨搬移技术也是治疗胫骨大段骨缺损合并软组织缺损的有效方法,尤其适用于骨缺损长度大于6cm的患者。     

Management of massive posttraumatic bone defects in the lower limb with the Ilizarov technique

Massive bone defects have been treated by various methods with variable success rates. The Ilizarov technique has been advocated as a preferred method for treatment of large segmental defects. Twenty five patients with massive post traumatic bone defects of the lower limb (22 tibiae, 3 femurs) were treated using Ilizarov's technique. After radiological evaluation, the patients were subjected to bone transport. Bifocal osteosynthesis was performed in all except those needing >12 cm of bone transport. Distraction was started between day 4 and 7 at the rate of 1 mm per day in four increments. All were males with a mean gap of 8.9 cm (range: 5-17 cm), mean age of 28.24 years (16-40) and having undergone a mean of 2.6 previous surgeries. Mean time in Ilizarov frame was 8.8 months and external fixator index was 0.98 months. Mean duration of follow-up after frame removal was 23.5 months. Union was achieved in 23 (92%) cases. Bone grafting was required in 9 (36%) According to ASAMI criteria, bone results were excellent in 13, good in 1, and poor in 11 patients. Functional results were excellent in 6 patients, good in 9, fair in 4, and poor in 6 patients. A total of 72 complications occurred (2.88 complications per patient). Union was achieved in all except two patients. The Ilizarov external fixator offers a limb salvage solution even in large bone defects but the surgeon should set realistic goals both for himself and his patients while offering this method of treatment.     

Treatment of tibial defect and bone nonunion with limb shortening with external fixator and reconstituted bone xenograft

Objective: To explore the effect of external fixator and reconstituted bone xenograft (RBX) in the treatment of tibial bone defect, tibial bone nonunion and congenital pseudarthrosis of the tibia with limb shortening. Methods : Twenty patients ( 13 males and 7 females)with tibial bone defect, tibial bone nonunion or congenital pseudarthrosis of the tibia with limb shortening were treated with external fixation, Two kinds of external fixators were used: a half ring sulcated external fixator used in 13 patients and a combined external fixator in 7 patients.Foot-drop was corrected at the same time with external fixation in 4 patients. The shortened length of the tibia was in the range of 2-9 cm, with an average of 4.8 cm. For bone grafting, RBX was used in 12 patients, autogenous ilium was used in 3 patients and autogenous fibula was implanted as a bone plug into the medullary canal in 1 case,and no bone graft was used in 4 patients. Results: All the 20 patients were followed-up for 8 months to 7 years, averaging 51 months. Satisfactory function of the affected extremities was obtained. All the shortened extremities were lengthened to the expected length. For all the lengthening area and the fracture sites,bone union was obtained at the last. The average healing time of 12 patients treated with RBX was 4.8 months. Conclusions: Both the half ring sulcated external fixator and the combined external fixator have the advantages of small trauma, simple operation, elastic fixation without stress shielding and non-limitation from local soft tissue conditions, and there is satisfactory functional recovery of affected extremities in the treatment of tibial bone defects, tibial bone nonunion and congenital pseudarthrosis of the tibia combined with limb shortening.RBX has good biocompatibility and does not cause immunological rejections. It can also be safely used in treatment of bone nonunion and has reliable effect to promote bone healing.