微创Ilizarov外固定架治疗胫骨感染性骨不连

Minimally invasive management of infected tibial nonunion by bone lengthening using the Ilizarov external fixation

目的评价Ilizarov外固定架下采用骨延长技术治疗胫骨感染性骨不连的临床结果及功能情况。方法22例胫骨感染性骨不连患者感染端进行清创后骨缺损的长度为4.1～12.6(6.72±2.42)cm。其中21例为小面积软组织缺损者,采用局部皮瓣转移覆盖,1例大面积软组织缺损者(8 cm×5 cm),采用腓肠肌皮瓣转移术覆盖创面,22例均采用Ilizarov外固定架进行骨延长治疗。结果22例均获得随访,时间12～24(17.64±3.84)个月。骨不连均获得愈合,愈合时间7～19(9.86±3.01)个月,感染均得到控制。10例在延长过程中有局部针道渗液,治疗后愈合。牵引成骨的长度为4.1～12.6(6.72±2.42)cm。根据Paley骨折愈合评分标准:优13例,良7例,中2例。结论对于胫骨感染性骨不连,使用Ilizarov外固定架进行骨延长治疗临床结果及功能恢复满意。

Objective To evaluate the clinical and functional outcomes of infected nonunion of tibia treated by bone lengthening using Ilizarov external fixation. Methods 22 patients who underwent bone lengthening for infected nonunion of tibia were reviewed. After debridement, the length of bone defect was 4. 1 - 12.6 （6. 72 ±2.42） cm . 21 with minor soft tissue defects were repaired by local skin flaps. 1 major soft tissue defect of 8cm×5cm was repaired by gastroenemius skin flap. Results All the patients were followed up for 12 - 24 （ 17.64 ± 3.84） months. All the cases got bony union in 7 - 19 （9.86 ± 3.01 ）months , and the infection was controlled. 10 cases got pin tract infections and healed in the process of bone lengthening. The length of bone regeneration was 4. 1 - 12.6 （6.72 ±2. 42 ） em . According to Paley scoring system for bone healing, there were 13 excellent ,7 good and 2 fair. Conclusions The clinical and functional outcomes are satisfactory in the management of infected tibial nonunion by bone lengthening using the Ilizarov external fixation .