Ilizarov牵张成骨技术治疗前臂感染性骨缺损疗效观察

EFFECTIVENESS OF Ilizarov TECHNOLOGY FOR INFECTED FOREARM NONUNION

目的探讨采用Ilizarov牵张成骨技术治疗前臂感染性骨缺损的方法及疗效。方法2004年1月-2014年3月，采用Ilizarov牵张成骨技术治疗前臂感染性骨缺损患者19例。其中男12例，女7例；年龄18～62岁，平均37．4岁。初始致伤原因：交通事故伤11例，高处坠落伤4例，机器绞伤4例。曾接受1—5次手术，平均2．7次。术后发生桡骨骨不连10例，尺骨骨不连7例，尺、桡骨骨不连2例。慢性感染时间4～16个月，平均8．3个月。彻底清创后骨缺损长度2．2～7．5cm，平均3．54cm。C臂x线机透视下采用OrthofLx单边可延长外固定支架固定。术后7。10d开始延长，定期复查X线片了解成骨情况。结果外固定支架固定时间3—12个月，平均6．5个月；外固定指数为1．14～2．15个月／cm，平均1．72个月／cm。19例均获随访，随访时间24—55个月，平均35．4个月。骨愈合时间3～11个月，平均6个月；无感染复发。10例存在不同程度的钉道反应，但未出现严重钉道感染，未进行特殊处理，正常换药后愈合。末次随访时腕关节屈曲42～55°，平均52．78°；背伸40～60°，平均46．53°。肘关节屈曲130～150°，平均139．23°；伸展0—20°，平均3．57°。前臂旋前68—90°，平均76．68°；旋后72～90°，平均81．75°。结论采用Ilizarov牵张成骨技术治疗前臂感染性骨缺损可获得满意临床疗效，彻底清创是控制感染的关键。

Objective To explore the effectiveness and method of Ilizarov technology for the treatment of infected forearm nonunion. Methods Between January 2004 and March 2014, 19 patients with infected forearm nonunion were treated, including 12 males and 7 females with a mean age of 37.4 years （range, 18-62 years）. The iniury causes included traffic accident in 11 patients, falling from height in 4 patients, and machine twist injury in 4 patients. The patients had received surgical treatment for 1-5 times （mean, 2.7 times）. Bone defects located at the radius in 10 cases, at the ulna in 7 cases, and at the radius and ulna in 2 cases. The mean time of chronic infection was 8.3 months （range, 4-16 months）. The mean length of the bone defects after debridement was 3.54 cm （range, 2.2-7.5 cm）. Under the guidance of C-arm fluoroscope, the Orthofix unilateral external fixator was used to fix. Distraction was performed at 7-10 days after operation, and X-ray film was taken regularly to detect the osteogenesis. Results The mean external fixation time was 6.5 months （range, 3-12 months）, and the mean external fixation index was 1.72 months/cm （range, 1.14-2.15 months/cm）. All patients were followed up for 35.4 months on average （range, 24-55 months）. The bone union time was 3-11 months （mean, 6 months）; and no recurrence of infection was observed. At last follow-up, the mean wrist range of motion （ROM） were 52.78°（range, 42-55°） in flexion and 46.53° （range, 40-60°） in extension; the mean elbow ROM were 139.23°（range, 130-150°） in flexion and 3.57° （range, 0-20°） in extension; and the mean forearm ROM were 76.68° （range, 68-90°） in pronation and 81.75° （range, 72-90°） in supination. Conclusion Ilizarov technology for infected forearm nonunion can acquire satisfactory clinical results. Radical debridement is the key to control bone infection.