MIPPO技术联合“橄榄式”植骨对胫骨骨不连治疗效果的研究

发布时间：2018-05-20 20:28

本文选题：MIPPO技术 + 胫骨骨不连　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：现如今骨不连已成为骨科的一大难题，它是骨折中比较常见的并发症，发生率在骨折病例中占3.4%。一些因素，如高能量创伤，感染，和医源性因素（过度剥离骨膜，血液供应破坏，缺乏软组织的保护）都会导致骨不连。胫骨骨不连患者存在许多问题：一些需要多次手术，小腿肌肉萎缩是一种常见的问题。许多患者完全失去信心，变得气馁和沮丧。传统的切开复位内固定可导致多种并发症。例如，皮肤坏死，软组织感染，骨折不愈合或延迟骨组织已经报道。我们采用了MIPPO技术联合一种新的“橄榄式”样植骨的方法治疗了18例胫骨骨不连患者，对术后患者骨折愈合和患肢功能情况进行评估。资料与方法：本文通过回顾性研究，自2010年至2013年我们共选取了18例患者，所有患者均为男性。患者的平均年龄为41岁（24 57年）。平均随访时间为10个月（3 23个月）。所有骨折均是由高能量损伤造成，包括机动车辆事故（摩托车或汽车）或从高处坠落伤。患者最初的治疗是使用外固定板或内固定板，但6个月后，胫骨骨不连依然发生，二次手术是必然的。X线照片可见骨折断端有硬化骨形成，髓腔闭塞，无骨小梁形成。按其骨不连发生的位置：胫骨近端（四例）；中端（四例）；远端（九例）；中下段（1例）。十例为多发性骨折，包括股骨骨折和胫腓骨粉碎性骨折，一例有神经损伤和血管损伤，六例为胫腓骨开放性骨折。11例使用了外侧板，6例使用了内侧板，，1例使用了前外侧板和内侧板。结果：我们分别在1个月，3个月，6个月和1年对所有患者进行影像学检查，并对影像学结果进行了评估。功能结果评分：优14例，良四例。并不需要二次手术。平均手术时间为75分钟（60 85分钟），术中照射时间为20秒（10 30秒）。所有患者在大约13周时再影像学上均获得了坚固的愈合（4 24周）。术后随访23个月。随访期内未见明显骨坏死骨，并且总出血量大约为80 130毫升。结论： MIPPO技术联合“橄榄式”植骨的手术方法在对胫骨骨不连的治疗上，可以很好地保护血运，促进骨折的愈合，并且手术的成功率是非常高的，随访期间，我们患者没有肢体疼痛，畸形，内固定失败，感染，血管或神经损伤，或皮肤坏死，初步证明了这种方法在治疗胫骨骨不连上是一种安全、有效的方法。
[Abstract]:Objective: Nowadays, nonunion has become a major problem in orthopedic department. It is a common complication in fracture, accounting for 3.4% of fracture cases. Some factors, such as high-energy trauma, infection, and iatrogenic factors (excessive exfoliation of periosteum, blood supply disruption, lack of soft tissue protection) can lead to nonunion. There are many problems in patients with tibial nonunion: some require multiple surgeries and leg muscle atrophy is a common problem. Many patients lose confidence completely and become discouraged and depressed. Traditional open reduction and internal fixation can lead to multiple complications. For example, skin necrosis, soft tissue infections, nonunion or delayed bone tissue have been reported. MIPPO technique combined with a new "olive-like" bone graft was used to treat 18 patients with tibial nonunion. Fracture healing and limb function were evaluated. Information and methods: From 2010 to 2013, we selected 18 patients, all of whom were male. The average age of the patients was 41 years old, 24 years and 57 years. The average follow-up time was 10 months and 23 months. All fractures are caused by high-energy injuries, including motor vehicle accidents (motorcycles or cars) or falls from high altitudes. The first treatment was external fixation or internal fixation, but after 6 months, nonunion of tibia still occurred. The second operation was inevitable. X-ray photos showed that the broken end of fracture had sclerosing bone formation, medullary cavity occlusion, and no trabeculae formation. According to the position of nonunion, the proximal tibia (4 cases), the middle end (4 cases), the distal end (9 cases), the middle and lower segment of the tibia (1 case). Ten cases were multiple fractures, including femoral fractures and comminuted fractures of tibia and fibula, and one case had nerve and vascular injuries. 6 cases of open fracture of tibia and fibula. 11 cases were treated with lateral plate. 6 cases used medial plate and 1 case used anterolateral plate and medial plate. Results: We evaluated the imaging findings of all patients at 1 month, 3 months, 6 months and 1 year. Functional score: excellent in 14 cases, good in 4 cases. There is no need for secondary surgery. The average operative time was 75 minutes, 60 minutes, 85 minutes, and the intraoperative irradiation time was 20 seconds, 10 minutes and 30 seconds. All patients received solid healing at about 13 weeks after re-imaging. Postoperative follow-up was 23 months. No osteonecrosis was found during the follow-up period, and the total bleeding was about 80 to 130 ml. Conclusion: The MIPPO technique combined with "olive-type" bone grafting in the treatment of tibial nonunion can well protect blood flow and promote fracture healing, and the success rate of the operation is very high, and during the follow-up period, our patients had no limb pain. Malformation, failure of internal fixation, infection, vascular or nerve injury, or skin necrosis have proved to be a safe and effective method for the treatment of tibial nonunion.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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