下肢骨不连后骨缺损的手术治疗

Surgical Treatment for Defective Bone Ununion of Lower Limbs

目的 探讨下肢缺损性骨不连各种治疗方法的优缺点和适应证 ,提出选择最佳治疗方案的意见。方法 回顾分析 1 2年来收治下肢缺损性骨不连 5 3例的临床资料。采用髓内和 /或髓外植骨、加压钢板或交锁髓内钉固定方法治疗 4 2例 ,其中股骨33例 ,胫骨 9例 ;采用Ilizarov技术治疗 1 1例 ,其中股骨 1例 ,胫骨 1 0例。结果 全部骨不连均顺利愈合 ,骨缺损均得到修复。植骨内固定方法骨愈合时间 4～ 2 4个月 ,平均 6个月 ,患肢负重及关节活动恢复较快 ;外固定器固定方法骨愈合时间 6～2 0个月 ,平均 9个月 ,患肢负重及关节活动恢复较慢。结论 明确提出应将局部软组织情况作为重要根据选择治疗方案的观点 ;植骨内固定方法要求植骨充分、内固定牢靠 ,强调植骨方式对骨结构重建有重要意义 ;对有骨与软组织缺损、骨外露的感染性骨不连的治疗 ,应采用Ilizarov技术 ,即先切除病损骨 ,行骨输送修复骨缺损 ,软组织创面可同时缩小、愈合 。

Objective To research the virtues and defects of several treating methods for defective bone ununion of lower limbs and to make a suggestion of the best treatment design.Methods The calinical data of 53 cases defective bone ununion of lower limbs were reviewed.Several methods,such as internal marrow bone graft,external marrow bone graft,compression plate fixation or internal marrow pin lock have been used for 42 patients.Of them,33 in femur,9 in tibia.Ilizarov technique has been used in 11 petients.Of them,one in femur and 11 in tibia.Results All of the defective bone ununion were healed,and the plerosis have been gotten successfully.Through internal fixation with bone graft,bone healing period was 4～24 months,average 6 months.The weight loading and joint function improved of affected extremity was rapid.Through external fixation device,bone healing period was 6～20 months,average 9 months.The weight loading and joint function improved of affected extremity was slowly.Conclusion The state of local soft tissue should be an important base for treating method chose.Internal fixation with bone graft demands full bone graft,reliable internal fixation,and emphasizes that the way of bone graft has important significant for bone structure reconstruction.For infective bone ununion with soft tissue defection,bone exposed,Ilizarov technique should be used.Resection lesion bone should be done firstly,then bone transportation should be done,at this period,the trauma in soft tissue would be decreased and healed.Finally,skin flap transfer should be performed.