联合Ilizarov及VSD技术治疗合并软组织缺损的胫骨干骨缺损

Ilizarov combined with VSD technique for the treatment of tibial bone defect combined with soft tissue defect

目的探讨Ilizarov技术及VSD技术联合使用在治疗合并软组织缺损的胫骨干骨缺损中的临床应用效果。方法选择2011年2月~2014年7月收治的合并软组织缺损的胫骨干骨缺损患者28例,男性18例,女性10例;年龄13~62岁,平均37.6岁。骨缺损长度2.5~10.8cm,平均6.7cm,软组织缺损面积(1.5cm×3.5cm^4.5cm×8.8cm,平均2.7cm×6.4cm)。一期清创,清除感染及粉碎严重的骨质,胫骨干骺端截骨,安装Ilizarov外固定架,VSD护创材料覆盖创面,术后1周行皮肤及骨组织同时推移。结果所有患者随访5~23个月,平均15个月。骨缺损均得以重建并骨性愈合,患侧肢体长度与健侧之差<1.5cm,创面均愈合。外固定指数1.3~2.5个月/cm,平均2.05个月/cm。结论联合Ilizarov及VSD技术治疗合并软组织缺损的胫骨干骨缺损疗效满意,实现了骨与软组织缺损的同期治疗。

Objective To investigate the effect of Ilizarov and VSD technique in the treatment of tibial bone defect combined with soft tissue defect.Methods A total of 28 patients（18 males and 10 females aged from 13-62 years with an average of 37.6 years） with tibial bone defect combined with soft tissue defect were fixed with Ilizarov and VSD technique from Feb.2011 to Jul.2014.The length of bone defect was 2.5-10.8 cm （ average, 6.7cm） and the soft tissue defect areas ranged from 1.5cm ×3.5cm to 4.5cm ×8.8cm（average,2.7cm ×6.4cm）. Thorough debridement of the bone defects was completed. Infected and severely crushed bone chips were cleared and metaphyseal tibial osteotomy was performed.External fixation was made with Ilizarov external fixator.VSD ma-terial was employed to cover the wound.Bone and soft tissue infection and defect were treated at the same time. Results All patients were followed up for an average of 15 months（5-23months）,which showed reconstruction of the bone defects and restoration of the limb length were achieved（ fracture healing was acquired and the length differ-ence was less than 1.5 cm）.External fixation index was from 1.3 month/cm to 2.5 month/cm（ average,2.05 month/cm） .Conclusion Ilizarov combined with VSD technique has good effect in the treatment of tibial bone de-fect combined with soft tissue defect,which simultaneously achieved the treatment of bone and soft tissue defects.