Ilizarov治疗胫骨骨缺损后小腿功能评价及相关因素分析

发布时间：2018-12-19 15:53

【摘要】：目的随着时代的不断进步,高能量创伤导致的胫骨大段骨缺损成为骨科临床医生面临的难题。20世纪50年代,前苏联科学家Ilizarov发明环形骨外固定器,并通过大量的临床实践及科研研究形成了张力-应力法则,再次于70年代独创骨搬移技术。通过国内外的临床实践研究,Ilizarov骨段滑移术可以有效地治愈胫骨大段骨缺损。而影响Ilizarov骨段滑移术治疗胫骨大段骨缺损疗效的相关因素报道较少。本课题对应用Ilizarov技术骨段滑移治疗胫骨大段骨缺损在6~10cm范围内的病例回顾性分析和归纳总结。探讨胫骨大段骨缺损行Ilizarov技术骨段滑移术的治疗效果及相关因素分析指导临床工作。方法对2008年1月~2014年6月,收治63例胫骨大段骨缺损患者进行回顾性分析:应用Ilizarov技术骨段滑移治疗胫骨上段骨缺损28例为A组,应用Ilizarov技术骨段滑移治疗下段骨缺损35例为B组。对A、B两组病例相关变量分析,对年龄、性别、骨缺损幅度、截骨平面以及对A、B两组去除外固定架后1个月、2个月、3个月、6个月进行小腿功能即膝、踝关节功能进行评定及统计学分析。结果63例患者术后平均随访15~24个月,胫骨骨缺损平均长度6cm~10cm,延长天数100天~150天,拆外固定架时间8个月~12个月,愈合指数35~41天/cm,所有骨缺损均愈合,愈合时间为7个月~23个月。所有患者骨缺损均达到愈合,患者去除环式外固定架后膝、踝关节功能明显恢复。结论1 Ilizarov技术骨段滑移治疗胫骨大段骨缺损术后效果显著。2大段胫骨骨缺损的患者经Ilizarov技术骨段滑移后撤除环式外固定架,通过功能锻炼可以恢复到与患者健侧小腿正常活动功能无明显区别。3 Ilizarov技术骨段滑移治疗胫骨大段骨缺损后,骨缺损幅度越大去除外固定架后膝、踝关节功能越差。4 Ilizarov技术骨段滑移治疗胫骨大段骨缺损后,年龄越大去除外固定架后膝、踝关节功能越差。5 Ilizarov技术骨段滑移治疗胫骨骨缺损截骨平面在胫骨下段比在胫骨上段术后膝、踝关节功能恢复差。
[Abstract]:Objective with the development of the times, the defect of large segment of tibia caused by high energy trauma has become a difficult problem for orthopedic clinicians. In the 1950s, Ilizarov, a former Soviet scientist, invented the ring bone external fixator. The tension-stress rule was formed through a lot of clinical practice and scientific research. According to the clinical research at home and abroad, Ilizarov segmental slippage can effectively cure the large tibial bone defect. However, the related factors affecting the treatment of large tibial bone defect with Ilizarov segmental slippage were less reported. In this study, we retrospectively analyzed and summarized the cases of large tibial bone defect treated by Ilizarov technique in the range of 6~10cm. Objective: to investigate the effect of Ilizarov technique in the treatment of large tibial bone defect and related factor analysis to guide clinical work. Methods from January 2008 to June 2014, 63 patients with large tibial bone defects were retrospectively analyzed. 28 patients with upper tibial bone defects were treated with Ilizarov technique. 35 cases of lower bone defect were treated with Ilizarov technique. The related variables were analyzed in two groups: age, sex, extent of bone defect, osteotomy level and knee function of calf after removal of external fixator for 1 month, 2 months, 3 months and 6 months after removal of external fixator in group A and B, respectively. Ankle function was evaluated and statistically analyzed. Results 63 patients were followed up for an average of 15 ~ 24 months, the average length of tibial bone defect was 6 cm / 10 cm, the lengthening time was 100 ~ 150 days, the time of removing external fixator was 8 months ~ 12 months, and the healing index was 3541 days / cm,. The healing time ranged from 7 months to 23 months. The bone defect of all the patients was healed, the knee was removed from the ring external fixator, and the ankle function was obviously restored. Conclusion (1) the effect of Ilizarov technique on the treatment of large tibial bone defect is remarkable. 2 the patients with large tibial bone defect were removed the ring external fixator after Ilizarov technique. There was no significant difference between the normal activity function of the leg and that of the normal leg by functional exercise. (3) after the large tibial bone defect was treated with Ilizarov technique, the greater the extent of bone defect was, the greater the removal of the external fixator and the knee. The worse the function of ankle joint was. 4 after the treatment of large tibial bone defect with Ilizarov technique, the older the knee was, the older the external fixator was removed. The lower the function of ankle joint, the worse the functional recovery of ankle joint was. 5. The level of osteotomy in the lower tibia was lower than that in the upper tibia.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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