骨外固定加压治疗胫骨干骨不连

The treatment of Tibialnon-union with Compressive External Fixtor.

目的 :通过观察半环槽式外固定器治疗胫骨骨不连的治疗效果 ,评价加压外固定对骨损伤修复的作用。方法 :采用半环槽式外固定器骨外加压固定治疗胫骨干骨不连 49例 (男 37例 ,女 12例 ) ,骨不连时间为 7～ 132个月。其中 7例感染性骨不连偏侧性骨缺损者 ,行病灶清除开放性植骨 ;5例感染性骨不连行病灶清除、内固定物取出、小腿皮瓣转位 ;10例骨不连、骨缺损伴伤肢短缩者 ,行胫骨干骺端截骨或骨骺牵伸延长。结果 :植骨全部成活 ,创面植皮获Ⅰ期愈合 ,肢体延长幅度 4.5～ 13 .5cm ,平均 7.5cm ,达到预期目标 ,49例患者均于术后 2 .5～ 10个月 ,获得骨愈合 ,平均 5 .4个月。结论 :骨外固定加压治疗胫骨干骨不连不仅具有确实的效果 ,而且有以下优点 :(1)方法简便、创伤小、局部血运干扰少 ;(2 )在局部感染的条件下仍可使用 ;(3)骨端始终保持有均匀的压应力和肢体功能锻炼时产生的生理应力刺激 ,有利于促进骨愈合 ;(4)可配合肢体延长联合使用 ,既治愈了骨不连 ,又均衡了双下肢长度 ,有利于肢体功能恢复。

Objective:Through observing the effect of half-ring fixator on the treatment of tibial non-union,to evaluate the compressive external fixation on the repairment of bone defect.Mothed:49 cases (37 cases male,12 cases female)of tibial non-union (the non-union occurred from 7 to 132 months)were treated by half-ring external fixator.meanwhile,7 cases accompanied by infection and bone defect treated with bone graft,5 cases accompanied by infection treated with internal fixtor remove and local flap transfer,10 cases accompanied by limbshorten treated with limb-lengthening at the same time of compressive fixation treatment.Result:18 cases of closed fracture with fixed failure.18 cases with infection(36.7%),10 case present,shorten limb with bone defect,the length of bone defect was from 2 to 10cm(mean 4.8cm).All cases were treated by half-ring external fixator with compnession.and opening bene graft were used in 7 cases with bone infection and defect,local transfered flap in 5 cases with bone exposure,bone lengthening in 10 case with limb shortening. Result:All cases had got perfect bone healing, healing time were from 2.5 months to 10 months.average 5.4 months.The limb shortening in 10 cases were corrected by bone lengthening,the length was from 4.5～13.5cm.average 7.5cm,the function of joint were improved.Conclusion:Compression external fixation is an effective method for treatment of tibial non-union.