Ilizarov骨搬移联合髓内引导针技术治疗胫骨创伤性骨缺损的疗效

Clinical efficacy of Ilizarov bone transport technique combined with intramedullary guiding pin for treatment of posttraumatic tibia bone defect

目的探讨Ilizarov骨搬移联合髓内引导针技术治疗胫骨创伤性骨缺损的临床疗效。方法采用回顾性病例系列研究分析2014年11月—2018年3月河北医科大学第三医院收治的17例胫骨创伤性骨缺损患者临床资料,其中男13例,女4例;年龄19~60岁[(37.2±13.4)岁]。清创后骨缺损长度为4.6~14.0 cm[(8.6±2.8)cm]。所有患者采用Ilizarov骨搬移技术治疗,通过联合髓内导针引导控制搬移骨块的力线。记录创面愈合情况、外固定时间、外固定指数(EFI)、患肢力线恢复情况。末次随访时根据Ilizarov方法研究与应用协会(ASAMI)评分系统评定骨和功能结果。根据Paley分类标准记录并发症情况。根据健康调查简表(SF-36)记录生理功能维度得分(PCS)、精神健康维度得分(MCS)评价生活质量,并与我国人口常模比较。结果患者外固定架去除后随访12~37个月[(29.9±4.4)个月]。创面在骨搬移后均实现闭合,无须皮瓣转移手术。外固定时间为242~801 d[(436.5±154.6)d],EFI为35.7~60.5 d/cm[(50.6±6.2)d/cm]。1例患肢残留成角畸形,其余均力线恢复。末次随访时所有患者均获得骨愈合,无感染复发。ASAMI评分骨愈合优良率88%,功能优良率94%。Paley分类并发症包括12个问题、7个障碍、1个后遗症。SF-36中PCS为(85.8±11.6)分,MCS为(69.6±11.1)分;与我国人口常模[PCS(87.6±16.8)分;MCS(78.8±15.4)分]相比,PCS差异无统计学意义(P>0.05),MCS差异有统计学意义(P<0.05)。结论Ilizarov骨搬移联合髓内引导针技术可实现创面和骨折愈合,控制感染,恢复良好的患肢力线,虽然伴有一些并发症和心理影响,但可恢复患肢生理功能,是治疗胫骨创伤性骨缺损的有效方法。

Objective To investigate the clinical effect of Ilizarov bone transport technique with assisted guiding pin in medullary cavity for treatment of posttraumatic bone defect of tibia.Methods A retrospective case series study was conducted to analyze the clinical data of 17 patients with post-traumatic bone defect of tibia admitted to Third Hospital of Hebei Medical University form November 2014 to March 2018.There were 13 males and 4 females,aged 19-60 years[(37.2±13.4)years].The bone defect length was 4.6-14.0 cm[(8.6±2.8)cm]after debridement.All patients underwent treatment with Ilizarov bone transport technique.The alignment of transport bone segment was controlled by a guiding pin in medullary cavity of tibia.Bone grafts were performed to accelerate fracture healing of docking point.The wound healing,bone healing,external fixation time,external fixation index(EFI),alignment recovery were recorded.Bone healing and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of Ilizarov(ASAMI).The complication was recorded according to Paley\s criteria.The physical component summary score(PCS)and mental component summary score(MCS)ware recorded according to the MOS 36-item Short-form Health Survey(SF-36)questionnaire and compared with the national norm to evaluate the quality of life.Results After removal of the apparatus,follow-up period was 12-37 months[(29.9±4.4)months].Wound healing was achieved without flap transfer.At the latest follow-up,all patients achieved bone healing without recurrent infection.External fixation time was 242-801 days[(436.5±154.6)days]and external fixation index was 35.7-60.5 d/cm[(50.6±6.2)d/cm].The affected extremity alignment was restored in all patients except for residual angular deformity in one patient.According to ASAMI,the excellent and good rate of bony results and functional results were 88%and 94%.According to Paley\s criteria,complications included 12 problems, 7 obstacles and 1 sequelae.The PCS and MCS in SF-36 questionnaire were(85.8±11.6)points and(69.6±11.1)points.Compared with the national norm[PCS:(87.6±16.8)points,MCS:(78.8±15.4)points],PCS showed no statistical difference(P>0.05),but MCS showed statistical difference(P<0.05).Conclusions Ilizarov bone transport combined with intramedullary guiding pin can accelerate wound and fracture healing,control infection and restore lower limb alignment.The physical function of the affected extremity can be restored in spite of some complications and psychological effects.The technique is an effective treatment for posttraumatic bone defect of tibia.