骨搬移技术治疗股骨干大段感染性骨不连的疗效

Clinical efficacy of bone transport technique in treatment of large segment infective nonunion of femoral shaft

目的探讨骨搬移技术治疗股骨干大段感染性骨不连的临床疗效。方法采用回顾性病例系列研究分析2012年6月～2015年10月解放军总医院收治的33例股骨干大段感染性骨不连患者临床资料，其中男25例，女8例；年龄19～58岁，平均34．6岁。初始受伤为开放性骨折23例，闭合性骨折10例。既往接受1～9次手术，平均2．3次。受伤至本次手术时间为7～60个月，平均34个月。患者均行骨搬移技术治疗，彻底清创后股骨缺损长度6～18cm，平均10．5cm，在C形臂X线机透视下，将单臂肢体重建外固定架固定于股骨外侧。观察术后创面愈合情况、骨性愈合时间、外固定指数（EFI）、并发症情况。采用改良Ilizarov方法研究与应用学会（ASAMI）标准对患肢功能进行评价。结果患者均获随访21～53个月，平均38．5个月。股骨缺损全部修复，创面愈合，未见感染复发。骨性愈合时间为8—25个月，平均13个月。EFI为1．13～1．83个月／cm，平均1．26个月／cm。钉道感染率为55％（18／33）。其中A型12例，B型5例，C型1例。患肢功能优18例，良6例，可5例，差4例，优良率为73％（24／33）。结论骨搬移技术治疗股骨干大段感染性骨不连，能够彻底控制感染，促进缺损修复，恢复患肢功能。

Objective To investigate the clinical effect of bone transport technique in the treatment of large segment infective nonunion of femoral shaft. Methods A retrospective case series study was conducted to analyze the clinical data of 33 patients with large segment infective nonunion of femoral shaft admitted to Chinese PLA General Hospital from June 2012 to October 2015. There were 25 males and eight females, aged 19-58 years （mean, 34. 6 years ）. In terms of the initial injury, 23 patients were with open fracture and 10 with closed fracture. All patients previously received 1-9 times of operation, with an average of 2. 3 times. The duration from injury to operation ranged from 7-60 months, with an average of 34 months. All patients underwent treatment with bone transport technique. After thorough debridement, the length of femoral defect ranged from 6 em to 18 em, with an average of 10.5 cm. The single arm limb reconstruction external fixator was placed on the lateral side of the femur under C-arm X-ray fluoroscopy. The wound healing, bone healing time, external fixation index （EFI） , and complications were recorded. The function of the affected limb was evaluated using the modified criteria of Association for the Study and Application of the Method of Ilizarov （ASAMI）. Results All patients were followed up for 21-53 months （average, 38.5 months）. Femoral defects were completely repaired, with no recurrent infection reported. Bone healing time ranged from 8 months to 25 months （average, 13 months）. The external fixation index （EFI） ranged from 1.13 months/cm to 1.83 months/cm, with an average of 1.26 months/cm. The infection rate of the nail tract was 55% （ 18/33 ）. Tbere were 12 patients with Type A, five with Type B, and one with Type C. The function of the affected limb was graded as excellent in 18 patients, good in six, fair in five, and poor in four, with an excellent and good rate of 73% （24/33）. Conclusions In the treatment of large segment infective nonunion of femoral shaft, bone transport technique can control the infection, promote defect repair, and restore the function of affected limbs.