Ilizarov技术骨与软组织侧向搬移治疗局灶性胫骨骨髓炎

Lateral transport of bone and soft tissue using Ilizarov method for focal tibial osteomyelitis

背景:骨感染合并皮肤软组织缺损是骨科治疗的难题之一,目前常规治疗方法是膜诱导技术和骨搬移技术,结合上述两种方法,提出了Ilizarov技术骨与软组织侧向搬移。目的:探讨Ilizarov技术骨与软组织侧向搬移治疗局灶性胫骨骨髓炎的可行性及临床疗效。方法:回顾性分析2019年9月至2020年10月Ilizarov技术骨与软组织侧向搬移治疗5例伴合并皮肤软组织缺损或多处窦道形成的局灶性胫骨骨髓炎患者的临床资料,男3例,女2例;年龄23~70岁。软组织缺损范围(2.5~5.0)cm×(4.0~12.0)cm;骨组织缺损长度4~8 cm,缺损宽度为胫骨周长的1/3~1/2。一期清创切除感染的皮肤窦道瘢痕和感染骨组织,抗生素骨水泥填充和覆盖创面,待创面无脓性分泌物渗出后二期行骨水泥取出,行侧向半皮质骨截骨,截骨块予橄榄针或克氏针折弯固定,安放改良Ilizarov外固定器进行侧向骨块及软组织搬移,牵伸速度1 mm/d,每日4~6次调节。根据Paley愈合标准对骨性愈合情况及功能恢复情况进行评价。结果:5例分别获得4~12个月随访。外固定时间为3.5~5.0个月。3例骨与软组织顺利靠拢愈合,2例出现克氏针的橄榄头或克氏针尾阻挡失效,更换或调克氏针继续牵伸后获得骨与软组织愈合。均未发生皮肤软组织坏死、骨外露、术后骨折等并发症,未影响或加重肢体功能障碍。根据Paley愈合标准对骨性愈合情况及功能恢复情况进行评价,5例均为优。结论:Ilizarov技术骨与软组织侧向搬移为局灶性骨髓炎合并皮肤软组织缺损提供了一种新的治疗方法,临床效果满意。

Background:Bone infection combined with skin and soft tissue defect is one of the difficult problems in orthopedic treatment.At present,the conventional treatment methods are membrane induction technology and bone transport technology.Combined with the above two methods,Ilizarov method of lateral transport of bone and soft tissue is proposed.Objective:To evaluate the feasibility and clinical efficacy of Ilizarov method of lateral transport of bone and soft tissue in the treatment of focal tibial osteomyelitis.Methods:Five patients with focal chronic tibial osteomyelitis with skin sinus or skin soft tissue defect receiving Ilizarov method of lateral transport of bone and soft tissue from September 2019 to October 2020 were selected in the retin the range of(2.5-5.0)cm×(4.0-12.0)cm,the length of the bone tissue defect was 4-8 cm,and the width was 1/3 to 1/2 of the tibia circumference.The infected skin sinus and infected bone tissue were removed in the first stage of debridement,and antibiotic bone cement was used to fill and cover the wound.After the wound was free of purulent secretion exudation,bone cement was removed in the second stage,and lateral hemicortical osteotomy was performed.The osteotomy block was fixed with an olive wire needle or Kirschner wire and a modified Ilizarov external fixator was placed to move the lateral bone block and soft tissue.The distraction speed was 1 mm per day,adjusted 4-6 times a day.Paley bone and function grading was used to evaluate function.Results:All patients were followed up for 4-12 months.The duration of external fixation was 3.5 to 5.0 months.The bone and soft tissue was healed completely in 3 patients,and the obstruction of the Kirschner wire was failed in 2 patients who were healed after the replacement of the Kirschner wire and the continuation of the stretching.No skin and soft tissue necrosis,bone exposure or postoperative fracture was observed.All patients were excellent according to Paley bone and function grading.Conclusions:Ilizarov method of lateral transport of bone and soft tissue in the treatment of focal osteomyelitis with soft tissue defect has a good clinical effect and is an optional method.