Ilizarov骨搬移结合换药治疗急性胫骨骨髓炎伴软组织缺损

Treatment of acute tibial osteomyelitis and massive soft tissue defection using Ilizarov bone transport and dressing change

目的分析Ilizarov技术结合换药治疗急性胫骨骨髓炎伴大面积软组织坏死的效果。方法回顾性分析2009年7月至2012年9月14例急性胫骨骨髓炎伴大面积软组织缺损患者行Ilizarov骨搬移结合换药治疗的临床资料。患者均为GustilluⅢ型患者，C型损伤11例，皆合并血管损伤11例。4例伴有对侧肢体损伤。男10例，女4例；年龄21～45岁，平均35岁。受伤至手术时间12～24d，平均19d。首先进行感染部位清创，术后伤口开放，然后行Ilizarov骨搬运技术治疗骨缺损同时换药治疗。末次随访时采用Paley骨与功能评分方法评定疗效。结果14例患者全部随访，随访时间24—36个月，平均27个月，修复骨缺损5—13cm，平均7cm，骨搬移完成时间术后2～6个月，平均4月。皮肤在骨搬移过程中全部愈合。骨折全部愈合。感染治愈13例，1例转为慢性骨髓炎，治愈率为93％。末次随访时Paley骨折愈合评分。优11例，良2例，可1例，优良率为93％；Paley功能评分结果：优10例，良2例，可2例，优良率为86％。结论换药结合Ilizarov骨搬移是治疗急性胫骨髓炎伴大面积软组织坏死的一种较安全、有效的方法。

Objective To investigate the clinical efficacy of Ilizarov bone transport combined with dressing change in the treatment of acute tibial osteomyelitis accompanied with massive soft tissue defection. Methods From July 2009 to september 2012, 14 patients with acute tibial osteomyelitis associsted with large-area soft tissue necrosis and defection were treated in Traumatic Orthopaedics Department of the Central Hospital of Binzhou. All cases were Gustillu Ill type open fracture, and Ⅲ C type injury in 11 casas accompanied with vascular injure. Associated with contratateral lower limb in 4 casas. They were 10 male and 4 female,aged from 21 to 45 years old（ average age of 35 years old）. The duration from injury to surgery ranged from 12-24 days,averaging of 19 days. All cases were treated first with excision of the infected or necrosis bone segment and soft tissue. The wound keep opening, followed by Ilizarov bone transport combined with dressing change to repair the bone and soft tissue defection. The clinical efficacy was assessed using the Paley＇s evaluation system at the last follow-up. Results All the patients were followed up for 24 to 36 months （ average of 27 months）. The bone defection rapaired was from 5 to 1 3 cm（ average of 7 era）. The mean duration of distraction was 4 months,range from 2 to 6 months. All cases＇ gain sufficient soft tissue coverage the later period of Ilizarov bone transport. All the fracture and bone defection were cured. Infection were cured in 13 cases, and 1 case converted to chronicle osteomyelitis, and the cure rate was 93%. According to the Paley＇ s system, the bone union was excellent in 11 cases, good in 2 cases, and fair in 1 Cases,with a good-to-excellent rate was 93%. The functional outcome was excellent in 10 cases, good in 2 cases, and fair in 2 cases ,with a good-to-excellent rate of 86%. Conclusion Ilizarov bone transport and dressing change is one reliable and effective treatment of tibial acute infected and soft tissue defection.