儿童严重骨缺损不连的治疗

Treatment for Severe Bone Defectin Children

目的：介绍Ｉｌｉｚａｒｏｖ外固定技术和自体腓骨游离移植术治疗儿童严重骨缺损不连的临床经验。方法：共１２例患儿接受治疗，８例既往植骨内固定治疗失败。８例采用Ｉｌｉｚａｒｏｖ技术，３例采用自体腓骨游离移植术，１例采用Ｉｌｉｚａｒｏｖ与自体腓骨游离移植复合技术。结果：１２例均获治愈，骨缺损得到补充，除１例外伴发的肢体短缩得到矫正。结论：应用Ｉｌｉｚａｒｏｖ技术可以在消灭骨缺损的同时矫正肢体不等长，并适用于软组织条件差的肢体。假关节可以旷置或切除，有３种加压方法可供选择。假关节两端残留骨特别短小、纤细、无法穿针固定的病例，应采用自体腓骨游离移植的方法治疗。

bjective: To describe the clinical practice of treatment for severe bone defect in children by Ilizarov technique and autogenic free fibular grafting. Methods: Twelve cases were included,8 of them had the history of failed bone grafting and internal fixation. Ilizarov technique was used in 8 cases,autogenic free fibular grafting in 3 cases and in 1 case the two methods were used in combination. Results: Complete healing were achieved in all cases. Defected bone was supplied and discrepancy of extremities were corrected except 1 case. Conclusions: Bone defect and associated discrepancy of extremities can be treated simultaneously by Ilizarov technique,and this technique can be applied under the condition of soft tissue scarring and poor blood supply in the extremity. Pseudoarthrosis can be left untreated or removed surgically. The 3 procedures of compression can be chosen according to varied indications. If bone stump is too short and thin that there is not enough space for external fixation,autogenic free fibular grafting is indicated.