应用Ilizarov技术治疗长管状骨缺损性骨不连

Treatment for the bone defect nonunion in long bone with Ilizarov technique

目的探讨和总结应用Ilizarov技术治疗长管状骨复杂缺损性骨不连的重建方式及疗效。方法1996年1月至2005年1月,收治长管状骨缺损性骨不连患者61例,男46例,女15例;年龄6～55岁,平均28.2岁。胫骨29例,股骨9例,肱骨11例,桡骨7例,尺骨5例。骨缺损长度4～14cm,平均6.4cm。选择骨缺损4￣6cm的30例患者行Ilizarov截骨肢体延长术,骨缺损6￣9cm的21例患者行Ilizarov骨节段截骨后传送延长术,骨缺损超过9cm的10例患者行同侧腓骨转移结合Ilizarov架固定术。平均骨延长4.8cm;随访时间10～84个月,平均47个月。结果61例骨缺损最终均达到骨性愈合,平均带架时间9个月,平均骨愈合时间7.1个月。21例78个针道低度感染和积液,原因为针道骨吸收和针道局部清洁护理差。1例腓骨转移患者带架期间摔伤后再骨折。股骨轴向偏移<3mm、向前外侧成角<10°者5例,其中股骨3例,肱骨2例,经调架后逐步矫正。结论应用Ilizarov技术修复长管状骨复杂缺损性骨不连的原则是彻底切除病灶,其次是考虑功能重建。Ilizarov技术是治疗长管状骨复杂缺损性骨不连、成功重建肢体长度的有效方法。

Objective To explore the Ilizarov reconstructive technique and its efficacy for the complicated bone defect in long bone. Methods From January 1996 to January 2005, totally 61 patients suffered with long bone defect were observed, which involved 46 males and 15 females with an average age of 28.2 years （range, 6-55 years）. The bone defect occurred on the tibia in 29 patients, femur in 9, humerus in 11, radius in 7, ulna in 5. The treatment was tailored to the different length of defect： 30 patients with defect 4-6 cm were treated with the Ilizarov osteotomy and lengthening method; 21 patients with defect 6-9 cm were treated with the segmental transporting technique; 10 patients with defect beyond 9 cm were treated with pedicle fibular graft and Ilizarov fixation. The average bone lengthening was 4.8 cm with the duration of follow up from 10 to 84 months（with an average of 47 months）. Results All the 61 cases averagely got bone union at 7.1th month and fixator removal at 8th month after operation, respectively. The low-grade infection and effusion occurred in 78 pin tracts on 21 patients, which were attributed to bone absorption around the pin and improper wound care. And still 1 patient with fibular transplantation got refracture due to trauma before the fixator removal. Conclusion The key point in the Ilizarov technique for the long bone defect nonunion is to excise the lesion thoroughly, and reconstitute it later. The Ilizarov technique is an effective method to treat the severe defect in long bone and restore the extremity length.