短缩-延长及骨搬运在胫骨感染性骨不连中的应用及疗效

Management of tibial infected nonunion using shortening-lengthening or bone transport: The application and effectivity

目的探讨短缩-延长及骨搬运技术治疗胫骨感染性骨不连的临床疗效。方法回顾性分析2011年8月至2015年8月应用短缩-延长或骨搬运治疗的34例胫骨感染性骨不连患者的临床资料。其中男29例,女5例;年龄23~69岁,平均(45.7±11.2)岁。清创后所有患者均有不同程度的骨缺损。应用短缩-延长技术治疗10例,骨缺损长度为1.5~8.0 cm,平均(2.9±1.7) cm;应用骨搬运技术治疗24例,骨缺损长度为3.0~12.0 cm,平均(7.8±3.4) cm。结果对所有患者随访24~60个月,平均36.7个月。所有患者均获得骨愈合,总平均愈合时间为4~24个月,平均(12.0±3.4)个月;短缩-延长患者的愈合时间为4~12个月,平均(7.2±2.4)个月;骨搬运患者的愈合时间为6~24个月,平均(14.6±4.4)个月;总平均外固定指数EFI为1.7月/cm,短缩-延长及骨搬运分别为1.4月/cm及1.8月/cm。改良Paley评估系统评价,骨愈合结果优26例,良7例,差1例,骨愈合优良率97%;功能结果优23例,良10例,差1例,功能优良率97%。随访期间无病例再次发生骨髓炎。并发症主要为钉道处炎症反应11例,钉道感染13例,对接端皮肤软组织嵌顿9例,对接端愈合不良10例,膝关节挛缩2例,足下垂4例。结论短缩-延长及骨搬运技术是治疗胫骨感染性骨不连的有效方法,具体方法的选择根据患者的骨及软组织缺损情况而定。

Objective To evaluate the effect of shortening-lengthening and bone transport in treating tibial infected nonunion. Methods A retrospective study was carried out from August 2011 to August 2015, including 34 patients with tibial infected nonunion and were treated with shortening-lengthening or bone transport. The study included 29 males and 5 females ,with an average age of (45.7±11.2) years (ranged from 23 to 69 years). Bone defects were recorded after the initial debridement in all 34 patients. Shortening-lengthening was performed in 10 cases with a mean bone defect of (2.9±1.7) cm (ranged from 1.5 to 8.0 cm), while bone transport was performed in 24 cases with a mean bone defect of (7.8±3.4) cm (ranged from 3.0 to 12.0 cm). Results The mean follow up was 36.7 months (ranged from 24 to 60 months). All 34 patients achieved bone union with an average union time of (12.0±3.4) months (ranged from 4 to 24 months), while the average union time of shortening-lengthening and bone transport were (7.2±2.4) months (ranged from 4 to12 months) and (14.6±4.4) months (ranged from 6 to 24 months) respectively. The total external fixation index (EFI) was 1.7 month/cm, while the EFI was 1.4 month/cm and 1.8 month/cm of shortening-lengthening and bone transport respectively. We evaluated the outcome according to Paley et al classification of bone and functional results. Bone results were excellent in 26 cases, good in 7 cases, and fair in 1 case, while the functional results were excellent in 23 cases, good in 10 cases, and fair in 1 case with a functional excellent and good rate of 97%. No recurrent osteomyelitis was recorded. The common complications including pin site inflammation (11 patients) and infection (13 patients), nonunion (10 patients), soft tissue invagination of docking site (9 patients), contractions of the knee (2 patients) and foot drop (4 patients). Conclusion Shortening-lengthening and bone transport are reliable in treating tibial infected nonunion. Appropriate strategies should be chosen judged by the specific circumstance of bone and soft tissue in tibial infected nonunion.