应用Ilizarov技术治疗胫骨感染性骨缺损并足下垂

Treatment of tibia bone defect of infection with foot-drop by Ilizarov technique

目的探讨应用Ilizarov技术治疗胫骨感染性骨缺损合并足下垂的临床疗效。方法应用Ilizarov技术一期治疗胫骨感染性骨缺损伴足下垂13例。术前根据患肢最大周径,内踝到胫骨结节长度,足下垂角度,病灶范围和骨缺损长度设计Ilizarov外固定延长架,手术彻底切除病灶区炎性肉芽、坏死组织及死骨,把外固定延长架套入小腿,在相应胫骨部位进行截骨和穿针,术后8 d以1.0 mm/d分3次延长胫骨,同时以3 mm/d的速度矫正足下垂。结果 13例均获得随访,时间12～36个月,平均18个月。所有患者胫骨延长段、骨折段均骨性愈合。结论对于感染性胫骨缺损合并足下垂的患者,应用Ilizarov技术一期治疗创伤小,避免多次复杂手术,缩短治疗时间和节省治疗费用。

Objective To investigate the efficacy of one stage treatment of the tibia bone defect of infection associated with foot drop using the Ilizarov technique. Methods Thirteen patients with the tibia bone defect of infection with foot drop were treated with the Ilizarov technique. The external fixing extending rack was designed according to the affected limb of maximal circumference, the length from inner maileolus to tibial tubercle, the angle of foot drop, the range of focus, and the length of bone defect, before the operation. The inflammatory granulation, necrotic tissue and dead bone in focal zone were resected thoroughly, and the external fixation extending rack was put around the lower leg. Osteotomy and internal were used in the corresponding tibial parts. 8 days after the operation, 1.0 mm/d was extended for the tibia in 3 times, meanwhile 3 mm/d was extended for the drop foot. Results All patients were followed from 12 to 36 months, the average time was 18 months. In all cases, the bone union was achieved in fracture part and extension part. Conclusion One stage treatment of the tibia bone defect of infection with foot drop using the Ilizarov method has minimal invasion with less complex surgeries, and could reduce the time and expense of treatment.