Ilizarov技术治疗胫骨感染性骨不连及骨缺损的临床研究

发布时间：2018-07-05 03:15

本文选题：llizarov技术 + 胫骨　；参考：《昆明医科大学》2015年硕士论文

【摘要】：研究背景：胫骨感染性骨不连及骨缺损是创伤骨科常见疾患。因常伴随小腿软组织缺损、骨外露,加之胫骨中下段自身血循环差,导致治疗极为困难。传统的治疗方法很难兼顾到治愈感染同时修复骨、软组织缺损,恢复伤肢长度,临近关节畸形矫正,后期常合并足下垂、跟腱挛缩、关节僵硬、肢体短缩等并发症。目的：探讨Ilizarov技术治疗胫骨感染性骨不连及骨缺损的临床疗效,分析该技术的优缺点及其最佳适应症。方法：回顾性分析成都军区昆明总医院自2012年7月至2014年12月收治的胫骨感染性骨不连及骨缺损15例,其中男10例,女5例；年龄20-55岁,平均36.5岁；交通伤10例,摔伤2例,压砸伤3例。感染性骨不连6例,感染性骨缺损9例,骨缺损长度2-15cm,平均8.5cm。所有病例均合并软组织缺损。5例合并足下垂畸形。9例一期行清创、Ilizarov外固定架固定、截骨、骨搬运：6例一期行清创、Ilizarov外固定架固定,二期截骨、骨搬运。12例创面开放换药,3例采取皮瓣转移修复创面,其中1例采用腓肠肌内侧头肌皮瓣修复,1例采用隐神经营养血管皮瓣修复,1例采用腓肠神经营养血管皮瓣修复。结果：所有患者均获12-24个月随访,平均18个月,均获得愈合,无一例感染复发,肢体功能良好,足下垂畸形矫正满意。术后定期行X线摄片检查评估骨愈合情况,愈合时间4-20个月,平均1O个月；肢体长度恢复良好,与健侧对比无明显差异。主要并发症：针道感染5例,骨端对位不良8例,皮肤牵拉痛12例,8例出现不同程度的踝关节功能障碍。结论：采取Ilizarov技术治疗胫骨感染性骨不连及骨缺损,疗效满意,该技术尤其适于胫骨大段骨缺损合并软组织缺损、肢体短缩、跟腱挛缩、足下垂等畸形的病例。
[Abstract]:Background: infectious nonunion and bone defect of tibia are common diseases in orthopedic trauma. Often accompanied by soft tissue defects of the leg, bone exposure, and poor blood circulation in the middle and lower tibia, treatment is extremely difficult. It is difficult to cure infection and repair bone and soft tissue defect, restore the length of injured limb, close to joint deformity correction, often complicated with foot droop, Achilles tendon contracture, joint stiffness, limb shortening and other complications. Objective: to investigate the clinical efficacy of Ilizarov technique in the treatment of tibial infectious nonunion and bone defect, and to analyze the advantages and disadvantages of Ilizarov technique and its optimal indications. Methods: from July 2012 to December 2014, 15 cases of infectious nonunion and bone defect of tibia were retrospectively analyzed in Kunming General Hospital of Chengdu military region, including 10 cases of male and 5 cases of female, aged 20-55 years (mean 36.5 years), 10 cases of traffic injury and 2 cases of falling injury. There were 3 cases of crush injury. Infectious nonunion occurred in 6 cases and infectious bone defect in 9 cases. The length of bone defect was 2-15 cm (mean 8.5 cm). All cases were complicated with soft tissue defect in 5 cases and foot droop deformity in 9 cases. All cases were treated with debridement Ilizarov external fixation, osteotomy, bone transport: 6 cases were treated with debridement Ilizarov external fixator and secondary osteotomy. Bone transfer. 3 cases were treated with flap transfer, 1 case with medial gastrocnemius musculocutaneous flap, 1 case with saphenous neurovascular flap and 1 case with sural neurovascular flap. Results: all the patients were followed up for 12 to 24 months with an average of 18 months. None of the patients had any recurrence of infection, good limb function and satisfactory correction of foot droop deformity. The healing time was 4-20 months with an average of 10 months, and the limb length recovered well, but there was no significant difference between the limb length and the normal side. The main complications were: needle infection in 5 cases, bone end misalignment in 8 cases, skin traction pain in 12 cases and ankle dysfunction in 8 cases. Conclusion: Ilizarov technique is effective in the treatment of tibial infectious nonunion and bone defect. This technique is especially suitable for large tibial bone defect with soft tissue defect, limb shortening, Achilles tendon contracture, foot drooping and so on.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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