Orthofix单臂轨道式外固定支架与Ilizarov环形外固定支架治疗胫骨创伤后骨髓炎骨缺损的疗效比较

Bone defects following post-traumatic tibial osteomyelitis treated by bone transportation with Orthofix versus Ilizarov external fixation

目的比较Orthofix单臂轨道式外固定支架与Ilizarov环形外固定支架治疗胫骨创伤后骨髓炎骨缺损的疗效。方法回顾性分析1996年1月至2015年1月行单节段骨搬运技术治疗的129例患者资料。男106例，女23例；年龄14～60岁，平均36．5岁。43例患者采用Orthofix单臂轨道式外固定支架固定治疗（Orthofix组），86例患者采用Ilizarov环形外固定支架治疗（Ilizarov组）。术后7～10d开始行骨搬运术，按1mm／d的速度搬运，分4次完成。随访记录并比较两组患者骨延长区域矿化时间、骨延长长度、带架时间、愈合指数、Et常生活能力量表（ADL）评分、焦虑自评量表（SAS）评分及膝关节活动受限范围、钉道松动等并发症发生情况。结果所有患者术后获13—216个月（平均96个月）随访。Orthofix组和Ilizarov组患者骨延长区域矿化时间、骨延长长度、带架时间、愈合指数比较差异均无统计学意义（P〉0．05）。Orthofix组与Ilizarov组患者ADL评分生活自理轻度受限分别为6、73例，生活自理基本不受限分别为37、13例；SAS评分轻度焦虑分别为33、16例，中度焦虑分别为8、63例，重度焦虑分别为2、7例；膝关节活动度受限（15°-30°）分别为39、10例，膝关节活动度受限（300～600）分别为4、76例，以上项目两组间比较差异均有统计学意义（P〈0．05）。Orthofix组和Ilizarov组总并发症发生率分别为79．1％（34／43）、88．4％（76／86），差异有统计学意义（P〈0．05）。结论Orthofix单臂轨道式外固定支架与Ilizarov环形外固定支架治疗胫骨创伤后骨髓炎骨缺损的临床治疗结果无明显差异，但后期对患者生活、心理有不同程度的影响，故需要根据两种治疗方式的优点及患者自身情况来决定治疗方案。

Objective To compare the curative effects of Orthofix extended external fixator versus Ilizarov external fixator in the treatment of bone defects following post-traumatic tibial osteomyelitis. Methods During the period from January, 1996 through January, 2015, 129 patients were selected for a retrospective analysis. They were 106 males and 23 females, aged from 14 to 60 years （average, 36.5 years）. Orthofix extended external fixator was used in 43 of them and Ilizarov external fixator in 86. Bone transportation started 7 to 10 days after surgery at a speed of 1 mm/d and was completed in 4 turns. The 2 groups were compared in terms of mineralization time for the extended bone, bone lengthening length, fixation time, union indexes, Activity of Daily Living Scale （ADL）, Self-Rating Anxiety Scale （SAS）, knee range of motion （ROM） and complications. Results The patients were followed up for 13 to 216 months （average, 96 months） . Orthofix group and Ilizarov group were not significantly different in mineralization time for the extended bone, bone lengthening length, fixation time or union indexes （ P 〉 0.05）. In Orthofix group and Ilizarov group respectively, there were 6 versus 73 patients with mildly limited self-living abilities and 37 versus 13 patients with little limited self-living abilities by ADL scores; there were 33 versus 16 cases of mild anxiety, 8 versus 63 cases of moderate anxiety and 2 versus 7 cases of grave anxiety by SAS scores; there were 39 versus 10 cases of limited knee ROM of 15° to 30° and 4 versus 76 cases of limited knee ROM of 30° to 60°. There were significant differences between the 2 groups in the above indexes （ P 〈 0. 05 ） . The rate of complications in Orthofix treatment group（79. 1%, 34/43） was significantly lower than in Ilizarov group （88.4%, 76/86） （ P 〈 0. 05 ）. Conclusions In the treatment of bone defects following post-traumatic tibial osteomyelitis, the curative effects of Orthofix extended external fixator are similar to those of Ilizarov external fixator. However, they may have different effects on the life and psychology of the patients in the long run. Therefore, specific therapeutic scheme should be decided in consideration of the advantages of the 2 treatments as well as the conditions of specific patients.