Ilizarov牵拉架外固定治疗胫骨骨缺损的钢环参数选择

Parameter selection for steel ring of Ilizarov external fixation in the treatment of tibial bone defects

背景:既往尚无有效的方法彻底治疗胫骨骨缺损合并软组织缺损。Ilizarov技术的应用能在一定程度上解决短缩畸形、软组织损伤及关节挛缩等相关问题。目的:探讨Ilizarov牵拉架外固定治疗胫骨骨缺损的效果及钢环的参数选择情况。方法:回顾性分析2007年3月至2012年1月收治且获得完整随访的胫骨骨缺损67例患者的临床资料,所有患者均为既往有胫骨骨折并一期行手术治疗,治疗后有胫骨骨髓炎合并骨与软组织损伤,在患肢上安放Ilizarov环形架外固定。比较外固定后1,3,6个月及末次随访时胫骨缺损长度和软组织缺损面积,观察外固定前后踝关节Kofoed评分和膝关节ROM评分有无差异,末次随访时根据Johner-Wruhs胫骨干骨折诊疗评价标准评定功能恢复情况。结果与结论:67例均得到随访,时间6-35个月。67例骨缺损得以重建,骨折愈合,但其中5例效果较差;44例软组织缺损病例中,40例创面闭合,4例创面未愈合。外固定后1,3,6个月及末次随访胫骨缺损长度和软组织缺损面积均较外固定前改善(P<0.05);外固定后踝关节Kofoed评分及膝关节ROM均较外固定前改善(P<0.05);末次随访时各种治疗方案疗效评价优良率为85%。对于合并皮肤缺损的胫骨骨髓炎性骨缺损,应用Ilizarov技术治疗胫骨骨缺损创伤小,能够避免多次复杂手术,缩短治疗时间和节省治疗费用,但也有一定的缺点和局限性。选用Ilizarov环形外固定架钢环的大小和材质对外固定效果和固定后调整均有一定影响。

BACKGROUND： There was no effective method to thoroughly treat tibial bone defect and soft tissue defect. The application of Ilizarov technique solved shortening deformity, soft tissue injury and joint contracture to some degrees. OBJECTIVE： To discuss the effects of Ilizarov external fixation on treatment of tibial bone defect and the parameter selection of Ilizarov steel ring. METHODS： We retrospectively analyzed the clinical data of 67 patients with tibial bone defects, who were treated and followed up from March 2007 to January 2012. All patients had fracture of tibia and received one- stage operation. After treatment, postoperative limb suffered from tibia osteomyelitis and soft tissue injury. Ilizarov external fixation was placed in the limb. The length of defected tibia and area of defected soft tissues were compared at 1, 3 and 6 months after external fixation and final follow-up. The ankle joint Kofoed score and knee joint ROM score were observed before and after external fixation. In final follow-up, functional recovery was evaluated in accordance with diagnosis and treatment criteria of Johner-Wruhs fracture of shaft of tibia. RESULTS AND CONCLUSION： A total of 67 patients were followed up for 6 to 35 months. Bone defects in 67 cases were rebuilt and the fracture was healed, but five cases had poor healing. Among 44 cases of soft tissue injury, wound had healed in 40 cases, and wound had not healed in 4 cases. The length of tibia defect and the area of soft tissue defects were improved at 1, 3, and 6 months after the operation （P 〈 0.05）. After operation, the ankle joint Kofoed score and knee joint ROM were significantly better than those before operation （P 〈 0.05）. During final follow-up, the excellent and good rate of each therapeutic plan was 85%. For the tibial osteomyelitis bone defect with the merged skin defect, the trauma was small using Ilizarov technique, which can avoid several complicated operations, shorten the time and reduce the expenses of treatment, but there were some weaknesses and limitations. The size and material of Ilizarov external fixation affect the efficiency of the fixation and postfixation adjustment.