混合式单臂外固定架骨延长术治疗感染性骨不连

The infected bone nonunion treated by hybrid mono-lateral external fixator combined with bone transport

目的评价混合式单臂外固定架骨延长术治疗长骨干骺端感染性骨不连的初步临床结果。方法2003年1月至2006年2月采用混合式单臂外固定架固定、局部清创和截骨延长法治疗感染性骨不连21例,男17例,女4例;年龄18～48岁,平均31.5岁。16例为开放骨折内固定术后感染,5例为闭合骨折内固定术后感染。胫骨近端12例,胫骨远端6例,股骨远端3例。12例行骨折端植骨,其中2例二次植骨。结果21例术后随访10～36个月,平均18个月。18例骨折获得初期愈合,3例骨折愈合时仍有局部窦道和渗液,2例骨折尚未完全愈合,1例行截肢术,20例感染得到控制。改良ASAMI骨评定结果为优良13例,中4例,差4例;功能评定结果为优良11例,中6例,差4例。平均骨延长5.6cm,平均愈合时间为11个月。15例发生钉道感染。结论对长骨干骺端感染性骨不连可使用混合式单臂外固定架骨延长术、骨折端开放换药的方法。该方法控制感染好,可自体修复骨缺损,供区畸形发生率低。但固定需采用HA涂层螺钉,严格控制延长速度,一般在1mm/d以内,分次进行延长,手术风险小。

Objective To evaluate the clinical outcomes of treating infected nonunion of the long bone metaphysis with soft-tissue defects or sinus using internal bone transport with the hybrid mono-lateral external fixator. Methods From January 2003 to February 2006, totally 21 patients （17 males, 4 females） were underwent hybrid mono-lateral external fixator for infected nonunion in the long bone metaphysis. The mean age of the patients was 31.5 years （range 18-48 years）. 16 infections happened after internal fixation for open fractures, and the other 5 did after internal fixation for close fractures. 12 patients were underwent cancellous bone grafting at docking sites （2 patients received two times）. The infected nonunion occurred on the distal femur in 3 patients, the proximal tibia in 12 patients, the distal tibia in 6 patients. Results 21 patients achieved follow-up. The mean follow-up periodwas 18 months （range 10-36 months）. 18 patients got primary bone union, including 3 patients keeping local sinus and exudate, and the other 2 patients were bony ununion, 1 surferred amputation. The infection was controlled in 20 patients. The bone and functional results were evaluated by the classification of the Association for the Study and Application of the Method of Ilizarove （ASAMI）. Bone results were 13 excellent and good, 4 fair and 4 poor. And functional results were 11 excellent and good, 6 fair and 4 poor. The mean time of healing were 11 months. The mean length of regenerating bone were 5.6 cm（2.5-8.0 cm）. 15 patients occurred pin track infection. Conclusion The long bone metaphysis infected nonunion can be successfully treated using the hybrid mnno-lateral external fixtor combined with internal bone transport technique. The infection of soft tissue can be controlled, and large bone defects can be treated with same bone diameter, limited donor-site morbility. Coating pins with hydroxyapatite can increase the bone fixation and reduce the rate of pin track infection and loosening during external fixation for distraction osteogenesis. And the distraction rate should be limited into 1 mm/d to decrease neurovascular complication.