单边外固定架与环形外固定架骨搬运技术治疗股骨骨髓炎并骨缺损的疗效比较

Comparison of efficacy between unilateral external fixator and circular external fixator in treatment of femoral osteomyelitis with bone defect

目的比较Orthofix单边外固定架与Ilizarov环形外固定架骨搬运技术联合抗生素硫酸钙治疗股骨骨髓炎并骨缺损的临床疗效。方法回顾性分析自2012-12—2018-12采用外固定架骨搬运技术联合抗生素硫酸钙治疗的76例股骨骨髓炎并骨缺损,37例采用Orthofix单边外固定架(单边组),39例采用Ilizarov环形外固定架(环形组)。比较2组骨愈合时间、骨愈合指数、骨延长长度、外固定架固定时间、外固定指数、外固定期间膝关节活动受限程度、钉道感染发生率。结果 76例均获得随访,随访时间平均43.5(12~72)个月。单边组与环形组在骨愈合时间、骨愈合指数、骨延长长度、外固定架固定时间、外固定指数、钉道感染发生率方面差异无统计学意义(P>0.05)。单边组外固定期间膝关节活动受限程度低于环形组,差异有统计学意义(P <0.05)。结论对于股骨骨髓炎合并骨缺损患者,通过Orthofix单边外固定架或Ilizarov环形外固定架骨搬运技术联合抗生素硫酸钙治疗可以控制感染、促进骨与软组织愈合,但Ilizarov环形外固定架固定对患者膝关节活动度的限制更大。

Objective To compare the clinical efficacy between Orthofix unilateral external fixator and Ilizarov circular external fixator combined with antibiotic calcium sulfate in the treatment of femoral osteomyelitis with bone defect.Methods From December 2012 to December 2018,76 cases of osteomyelitis with bone defect were treated with external fixator combined with antibiotic calcium sulfate.Thirty-seven cases were treated with Orthofix unilateral external fixator(unilateral group)and 39 cases with Ilizarov circular external fixator(ring group).The bone healing time,bone healing index,bone length lengthened,external fixation time,external fixation index,limitation of knee joint movement during external fixation,and incidence of nail track infection were compared between the two groups.Results All the 76 cases were followed up for an average of 43.5(12-72)months.There was no significant difference in bone healing time,bone healing index,bone length lengthened,external fixation time,external fixation index and the incidence of nail infection between the unilateral group and the ring group(P>0.05).During the period of external fixation,the limitation of knee joint movement in unilateral group was lower than that in ring group,the difference was statistically significant(P<0.05).Conclusion For patients with femoral osteomyelitis complicated with bone defect,Orthofix unilateral external fixator or Ilizarov circular external fixator combined with antibiotic calcium sulfate can control infection and promote bone and soft tissue healing,but Ilizarov circular external fixator has a greater limit effect on the range of motion of knee joint.