改良骨牵张结合非主干血管带蒂皮瓣移植治疗感染性胫骨缺损

Treatment of tibia infectious defect by distraction osteogenesis affiliated by circular external fixator combined with pedicled flap transplantation

目的探讨带蒂非主干血管皮瓣移植结合环形外固定支架改良截骨牵张对外伤导致的胫骨感染性骨缺损合并皮肤缺损临床治疗效果。方法创面彻底清创,切取带蒂非主干血管皮瓣转移修复软组织缺损,应用环形外固定支架加压固定胫骨缺损端,在胫骨近端横行截骨,术后第7天开始延长,每天延长1 mm,分2次完成,直至恢复胫骨正常长度。结果 2005年09月—2009年12月,治疗的22例患者均手术顺利,骨感染得到有效控制,术后随访6个月至3年,创面一期修复,骨愈合良好,感染未再复发。患肢经延长后恢复到正常长度,2例患者因跟腱挛缩轻度足下垂。结论改良胫骨截骨骨延长结合非主干血管带蒂皮瓣移植治疗外伤导致的骨感染性缺损合并皮肤缺损效果良好。

Objective To evaluate clinical treatment effects of tibial infectious defect due to trauma by distraction osteogenesis affiliated by circular external fixator combined with pedicled flap transplantation. Methods Debridement was done firstly, then soft tissue was repaired with pedicle flap and ostehomy was done at the level of the proximal metaphysis of tibia. The fracture were fixed with circular external fixator with certain pressure and the tibia were extended lmm per day until the bone segments contacted with each other. Results From September 2005 to December 2009, 22 patients were treated with above method. All of them went well and the osteomyelitis was effectively controlled. The patients were followed up for 6 months to 3 years. The wounds and the fractures healed well. No inflammation recurred. The involved limbs got normal length after extending. Only 2 cases occurred foot ptosis due to achilled tendon contracture. Conclusion Distraction osteogenesis affiliated by circular external fixator combined with pedicled flap transplantation is an effective methods for treatment of infectous tibia defect combined with soft tissue defect.