Ilizarov技术骨短缩-延长治疗无血管损伤的胫骨与软组织缺损

目的探讨Ilizarov技术骨短缩-延长治疗无血管损伤的胫骨与软组织缺损的疗效。方法回顾性分析2007年1月至2017年10月无锡市第九人民医院骨科采用Ilizarov技术骨短缩-延长治疗的28例无血管损伤的胫骨与软组织缺损患者资料。男20例,女8例;年龄18~69岁,平均36.4岁。均为创伤性骨折,GustiloⅡ型5例,ⅢA型6例,ⅢB型17例。17例合并感染。清创或扩创后创面皮缺损范围4 cm×3 cm^16 cm×5 cm,骨缺损长度4.5~11.0 cm(平均6.9 cm)。急性短缩3~7 cm后直接缝合或局部皮瓣转移或游离植皮,或术后逐渐短缩创口延迟闭合。术后观察创口愈合、骨愈合、下肢功能恢复和并发症等情况。骨愈合和下肢功能恢复分级按照Ilizarov技术研究与应用学会(ASAMI)标准分别评定。Ilizarov手术相关并发症按照Paley标准分为主要和次要并发症。结果创口愈合时间13~35 d(平均21.9 d),缺损端靠拢时间为0~75 d(平均21.8 d)。所有患者术后获12~45个月(平均20.5个月)随访。延长段骨愈合时间6~12个月(平均8.9个月);缺损端1例骨不连,骨愈合时间6~11个月(平均8.3个月)。ASAMI骨愈合分级优良率为100%(28/28),ASAMI下肢功能恢复优良率为89.3%(25/28)。Ilizarov术后主要并发症发生率为14.3%(4/28),次要并发症发生率为57.1%(16/28),总体并发症发生率为60.7%(17/28),并发症人次平均为1.7个/例。结论Ilizarov技术骨短缩-延长治疗无血管损伤的胫骨与软组织缺损,可以解决皮肤等软组织缺损修复困难难题,具有简化创口闭合、骨缺损端骨愈合较快、愈合率较高、并发症相对较少和肢体功能恢复满意等特点。

Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury

Objective To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics,Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females,aged from 18 to 69 years(average,36.4 years).By the Gustillo classification,5 cases belonged to typeⅡ,6 to typeⅢA and 17 to typeⅢB.Infection was complicated in 17 cases.After debridement or epluchage,the area of skin defects ranged from 4 cm×3 cm to 16 cm×5 cm and the length of bone defects from 4.5 to 11.0 cm(average,6.9 cm).The wound healing,bone healing,functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov(ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results The follow-up for all the patients lasted from 12 to 45 months(average,20.5 months).The healing time for wounds ranged from 13 to 35 days(average,21.9 days),the healing time for lengthened bone from 6 to 12 months(average,8.9 months),and the healing time for bone defects at the dock sites from 6 to 11 months(8.3 months).According to the ASAMI grading,the bone healing was excellent in 21 cases and good in 7,giving an excellent to good rate of 100%(28/28)while the functionary recovery of lower extremity was excellent in 10 cases,good in 15,fair in 2 and poor in one,giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28)for major complications after Ilizarov surgery,57.1%(16/28)for minor complications,60.7%(17/28)for overall complications,and 1.7 times for each case.Conclusion In the treatment of tibial defects of bone and soft tissue without vascular injury,Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects,characterized by simplified wound closure,fast and improved bone healing at the dock sites,reduced complications and satisfactory functionary recovery of lower extremity.