骨搬运胫跟融合术治疗外伤性距骨骨感染或缺损

Tibiocalcaneal arthrodesis via bone transport technique for traumatic talus infection or defect

目的探讨外固定架行骨搬运胫跟融合术治疗外伤性距骨骨感染或缺损的临床疗效。方法采用回顾性病例系列研究分析2011年6月—2017年10月山东大学附属省立医院收治的15例距骨骨感染或缺失损患者临床资料,其中男13例,女2例;年龄19~47岁,平均27岁。13例为距骨骨感染,2例为距骨缺失。均实施外固定架骨搬运胫跟融合术,其中环形外固定架治疗4例,单边外固定架治疗11例。6例感染严重患者行Ⅰ期清创,Ⅱ期截骨搬运术,其余9例清创、截骨搬运术同期进行。记录新增骨长度、外固定架固定时间,观察并发症情况。采用美国足踝外科协会(AOFAS)踝-后足功能评分对疗效进行评价。结果患者均获随访18~35个月,平均26个月。胫骨近段截骨区新生骨长度为5~16 cm,平均9 cm。对接端骨质愈合、截骨搬运处新生骨成熟后去除外固定架。外固定架固定时间13~27个月,平均18个月。随访期间患者均未发生断针、感染复发及跟骨内翻等并发症,且双下肢等长。AOFAS踝-后足功能评分由术前(42.0±3.6)分(31~55分)提高至末次随访(76.0±4.2)分(69~86分)。结论外固定架行骨搬运胫跟融合术是治疗距骨骨感染或缺损的一种有效方法,能修复清创后遗留的骨缺损,明显改善踝-后足功能,提高生活质量。

Objective To investigate the clinical efficacy of tibiocalcaneal arthrodesis using bone transport technique in the treatment of traumatic talus infection or loss.Methods A retrospective case series study was conducted to analyze the clinical data of 15 patients with talus infection or loss admitted to the provincial hospital affiliated to Shandong University from June 2011 to October 2017.There were 13 males and two females,aged from 19 to 47 years,with an average age of 27 years.Thirteen patients had talus infection and two patients had talus loss.All patients underwent tibiocalcaneal fusion with external fixator using bone transport technique,including four patients treated with annular external fixator and 11 with unilateral external fixator.Six patients with severe infection underwent debridement at stage I and osteotomy at stage II,and the other nine underwent debridement and osteotomy at the same time.The length of new bone,the fixation time of external fixator and complications were recorded.The American Orthopedic Foot and Ankle Society(AOFAS)score was used to evaluate the efficacy.Results All patients were followed up for 18-35 months,with an average of 26 months.The length of new bone in proximal tibial osteotomy area was 5-16 cm,with an average of 9 cm.The external fixators were removed after bone healing at docking site and maturation of new bone.The fixation time of external fixator ranged from 13 to 27 months,with an average of 18 months.No complications such as needle breakage,recurrence of infection and calcaneal varus occurred,and the length of both lower limbs was equal.AOFAS score was increased from preoperative(42.0±3.6)points(31-55 points)to(76.0±4.2)points(69-86 points)at the last follow-up.Conclusion Tibiocalcaneal arthrodesis using bone transport technique is proved to be effective in treating traumatic talus infection or loss,which can repair the bone defect after debridement,improve the ankle-hindfoot function and improve the quality of life.