手风琴技术促进骨搬移延长骨段骨质矿化的临床观察

Clinical observation of accordion technique in promoting bone transport and prolonging newborn bone mineralization

目的:探讨骨搬移治疗胫骨骨缺损时采用“手风琴”技术对延长骨段骨质矿化的影响。方法:自2017年5月至2019年10月,采用Ilizarov骨搬移技术治疗胫骨骨缺损患者22例,在骨搬移结束后,采用随机数字表法将22例患者随机分为两组。观察组11例,男9例,女2例;年龄20~60(42.6±13.3)岁;骨缺损长度3~13(6.4±2.6)cm;胫骨上段骨缺损2例,中段3例,下段6例;采用“手风琴”技术操作35 d。对照组11例,男10例,女1例;年龄41~60(51.6±6.4)岁;骨缺损长度3.0~10.7(6.6±2.5)cm;胫骨上段骨缺损1例,中段3例,下段7例;采用锁定外固定架等待矿化。分别测量两组在骨搬移结束后即刻及结束后35、65、95 d延长骨段的羟基磷灰石(hydroxylapatite,HAP)含量,比较两组患者的矿化时间及愈合时间,并采用Paley评分标准评价骨缺损的治疗效果。结果:22例患者获得随访,时间18~36(27.0±6.3)个月。骨缺损处伤口均在骨搬移过程中自然愈合,无皮肤感染、皮肤坏死等伤口并发症发生。两组骨搬移结束后35、65、95 d延长骨段的HAP含量比较差异有统计学意义(P<0.05)。两组矿化时间和愈合时间比较差异有统计学意义(P<0.05)。采用Paley评价标准对骨缺损治疗结果进行评价:观察组优10例,良1例;对照组优9例,良2例;两组比较差异无统计学意义(Z=-0.607,P=0.544)。结论:“手风琴”技术与单纯锁定外架矿化对骨搬移结束后延长骨段愈合的疗效相当,但“手风琴”技术能够明显加快HAP的增长速度,缩短矿化时间及愈合时间。

Objective:To analyze effect of accordion technique on bone mineralization of extended bone segment in treating tibial bone defect with bone transport.Methods:From May 2017 to October 2019,22 patients with tibial bone defects were treated with Ilizarov bone-transport technique,and divided into two groups after bone-transport was completed,11 patients in each group.In observation group,there were 9 males and 2 females aged from 20 to 60 years old with an average of(42.6±13.3) years old;the length of bone defect ranged from 3 to 13 cm with an average of(6.4±2.6) cm;2 patients were suffered from upper tibial bone defects,3 patients were middle and 6 patients were lower;patients were treated with accordion technique for35 days.In control group,there were 10 males and 1 female aged from 41 to 60 years old with an average of(51.6±6.4) years old;the length of bone defect ranged from 3 to 10.7 cm with an average of(6.6±2.5) cm;1 patient was suffered from upper tibial bone defects,3 patients were middle and 7 patients were lower;patients were treated with lock external fixator to waiting bone mineralization.The content of hydroxyapatite(HAP) extended bone segment was measured after bone-transport completed immediately,35,65 and 95 days after bone-transport was completed,respectively,then the mineralization time and healing time were compared between two groups,and the therapeutic effect of bone defect was evaluated by using Paley scoring criteria.Results:Twenty-two patients were followed up from 18 to 36 months with an average of(27.0±6.3) months.The wounds on the bone defects healed spontaneously during bone transport,and there were no wound complications such as skin infection or skin necrosis occurred. There were statistical difference in the content of HAP of the extended bone segments at 35,65 and 95 days after bone-transport between two groups(P<0.05).There were difference in mineralization time and healing time between two groups(P<0.05).According to Paley standard evaluation,10 patients got excellent results,and 1 good in observation group;while 9 patients got excellent results,2 good in control group;and there was no differences between two groups(Z=-0.607,P=0.544).Conclusion:Accordion technique and locking external fixator mineralization in prolonging bone segment healing after bone-transport have the equal clinical effect,while the accordion technique could significantly accelerate the growth rate of HAP and shorten the mineralization time and healing time.