骨搬移术与植骨内固定术治疗胫骨骨缺损的临床对比分析

发布时间：2018-04-02 14:20

本文选题：胫骨骨不连　切入点：骨缺损　出处：《广西医科大学》2015年硕士论文

【摘要】：目的回顾性分析比较骨搬移术与植骨内固定术两种手术方法治疗胫骨骨缺损的临床疗效,比较两种手术方式的优缺点,并讨论各自的禁忌证、适应证、并发症,为临床胫骨骨缺损的治疗提供决策参考。方法回顾性分析广西医科大学第一附属医院自2005年6月至2015年2月分别采用胫骨骨搬移术(骨搬移组15例)和植骨内固定术(植骨内固定组22例)治疗的胫骨骨缺损病例,对骨搬移组进行7个月～15个月随访,植骨内固定组进行3.2个月～10个月随访。比较两种方法修复骨缺损长度、手术切口长度、手术时间、术中出血量、术后管理、骨折临床愈合率及愈合时间、并发症及住院时间、住院费用,分析两种方法的优缺点及各自最佳的适应证。结果两组37例病例均获得随访,骨搬移组平均随访10.7个月,植骨内固定组平均随访6.4个月。两组病例在手术切口长度、手术时间、术中出血量、骨折临床愈合时间、住院时间、住院费用方面有统计学差异(P0.05),骨搬移组手术切口较短、术中出血量较少,但手术时间、骨折愈合时间、住院时间均较长,住院费用也相对较高。骨搬移组修复骨缺损长度2.5～14cm,平均(6.3±3.4)cm,4例搬移对合处发生了骨不连,予取自体骨植骨治疗后愈合,4例出现不同程度的足下垂畸形,4例出现钉道感染,4例出现疼痛,骨折临床愈合率73.3%；植骨内固定组修复了骨缺损2.3-4.2cm,平均(3.1±0.5)cm,有6例再次出现骨端不愈合,其中3例经再次自体骨植骨后骨性愈合,3例经骨搬移后愈合,有1例出现取骨区感染,二期清创后好转,有1例出现手术切口感染,抗炎治疗后好转,5例出现疼痛,骨折临床愈合率72.7%,有6例患者仍有0.8～1.5cm左右的患肢短缩存在。结论骨搬移术和植骨内固定术两种方法均能达到有效的治疗,二者各有优势：骨搬移术无需植骨,减少取骨植骨的并发症,对大段骨缺损有着疗效确切,对软组织要求相对较低,另外对慢性骨髓炎也可以达到有效的治疗。植骨内固定组对小段骨缺损的疗效确切,手术操作简单,并发症相对少。
[Abstract]:Objective to compare the clinical effects of bone transfer and internal fixation in the treatment of tibial bone defect, compare the advantages and disadvantages of the two surgical methods, and discuss their contraindications, indications and complications.To provide a reference for clinical treatment of tibial bone defect.Methods from June 2005 to February 2015, the cases of tibial bone defect treated by tibial bone transfer (15 cases in bone transfer group) and internal fixation (22 cases in bone graft fixation group) were retrospectively analyzed in the first affiliated Hospital of Guangxi Medical University.The bone transfer group was followed up from 7 months to 15 months, and the bone graft fixation group was followed up from 3.2 months to 10 months.The length of bone defect, the length of incision, the time of operation, the amount of intraoperative bleeding, the postoperative management, the rate of fracture healing and healing time, the complications and hospital stay, the cost of hospitalization were compared between the two methods.The advantages and disadvantages of the two methods and their best indications were analyzed.Results 37 cases in both groups were followed up. The average follow-up was 10.7 months in the bone transfer group and 6.4 months in the internal fixation group.There were significant differences in incision length, operative time, intraoperative bleeding amount, fracture healing time, hospitalization time and hospitalization cost between the two groups (P 0.05). The operative incision was shorter and the amount of intraoperative bleeding was less in the bone transfer group, but the operative time was less.Fracture healing time, hospital stay longer, hospitalization costs are relatively high.In the bone transfer group, the length of repair bone defect was 2.514 cm, the average length of bone defect was 6.3 卤3.4 cm ~ (-1), 4 cases had nonunion, 4 cases had healing after bone grafting, 4 cases had nail tract infection and 4 cases had pain.After secondary debridement, there was 1 case with incision infection and 5 cases with pain after anti-inflammatory therapy. The clinical healing rate of fracture was 72.7%. There were 6 patients with 0.8~1.5cm or so with short limb contraction.Conclusion both bone transfer and internal fixation of bone graft can achieve effective treatment. The two methods have their own advantages: there is no need for bone grafting, and the complications of bone grafting are reduced, which is effective for large segment bone defect.Soft tissue requirements are relatively low, in addition to chronic osteomyelitis can achieve effective treatment.The internal fixation group was effective in the treatment of small bone defects, simple in operation and less in complications.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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