四肢长干骨骨缺损的系统化新分型研究

A new classification and treatment system of limb long bone defects

目的探讨四肢长干骨骨缺损的系统化新分型的提出及其临床意义。方法结合既往Gustilo-Anderson开放性骨折分型和美国创伤骨科协会分型,以骨缺损长度为分型基础,结合软组织损伤和感染情况,提出四肢长干骨骨缺损的系统化新分型,用以指导四肢长干骨骨缺损的治疗策略选择。结果四肢长干骨骨缺损的系统化新分型分为3型:Ⅰ型:骨缺损长度<4 cm,再分为4个亚型,Ⅰa型:单纯骨缺损,缺损范围小,Ⅰb型:骨缺损伴有软组织缺损,Ⅰc型:骨缺损伴有感染,Ⅰd型:骨缺损同时伴有软组织缺损和感染;Ⅱ型:骨缺损长度为4~10 cm,也分为4个亚型,Ⅱa型:单纯骨缺损,缺损范围较大,Ⅱb型:骨缺损伴有软组织缺损;Ⅱc型:骨缺损伴有感染,Ⅱd型:骨缺损同时伴有软组织缺损和感染;Ⅲ型:骨缺损长度>10 cm,也分为4个亚型,Ⅲa型:单纯骨缺损,缺损范围大;Ⅲb型:骨缺损伴有软组织缺损,Ⅲc型:骨缺损伴有感染,Ⅲd型:骨缺损同时伴有软组织缺损和感染。结论四肢长干骨骨缺损的系统化新分型更加高效、直观,而且可以根据该分型对四肢长干骨骨缺损制定针对性的治疗策略。

Objective To establish an efficient classification and treatment system for limb long bone defects.Methods Based on the length of bone defect,soft tissue injury and wound infection,a new classification and treatment system was proposed with reference to Gustilo-Anderson classification for open fractures and Orthopedic Trauma Association(OTA)classification.Results We divided the limb long bone defects into 3 types,each of which was subdivided into 4 subtypes depending on concomitant soft tissue defect and/or infection.TypeⅠare bone defects less than 4 cm in length,including typeⅠa(simple bone defects with a limited extent),typeⅠb(bone and soft tissue defects),typeⅠc(bone defects with infection)and typeⅠd(bone defects with infection and soft tissue defects).TypeⅡare bone defects ranging from 4 to 10 cm in length,including typeⅡa(simple bone defects with a large extent),typeⅡb(bone and soft tissue defects),typeⅡc(bone defects with infection)and typeⅡd(bone defects with infection and soft tissue defects).TypeⅢare bone defects larger than 10 cm in length,including typeⅢa(simple bone defects with a very large extent),typeⅢb(bone and soft tissue defects),typeⅢc(bone defects with infection)and typeⅢd(bone defects with infection and soft tissue defects).Conclusion Our new classification and treatment system for long limb bone defects is more efficient and intuitive,facilitating clinical diagnosis and treatment of limb long bone defects.