环形外固定架骨搬移治疗胫骨中下段感染性骨不连的疗效分析

Effect of Bone Transport by Circular External Fixator in the Treatment of Infectious Nonunion of the Middle and Lower Tibia

目的探讨应用环形外固定架的骨搬移技术治疗胫骨中下段骨折术后感染性骨不连的临床疗效。方法回顾性研究2016年1月至2018年12月期间,我科收治的采用清创+Ⅰ期节段性截骨、骨搬移术治疗的19例胫骨骨折术后感染性骨不连的患者,其中男16例,女3例;年龄37~62岁,平均(46.2±11.8)岁。分析并评估本组患者的手术时间、手术次数、愈合指数、带架时间、骨搬移长度、术后并发症发生率和Baird-Jackson踝关节功能评分及美国特种外科医院(the hospital special surgery,HSS)膝关节功能评分。结果19例患者均获随访,随访时间12~30个月,平均(16.9±6.8)个月。手术时间100~150 min,平均(120.6±18.6)min;手术次数1~3次,平均(1.2±0.4)次;愈合指数31~52 d/cm,平均(39.4±8.2)d/cm;带架时间12~21个月,平均(15.2±3.0)个月;骨搬移长度4~11 cm,平均(7.2±2.2)cm。所有患者无感染复发,均获得骨性愈合。Baird-Jackson踝关节功能评分72~97分,平均(83.4±7.1)分。HSS膝关节功能评分80~98分,平均(89.2±5.4)分。术后并发症包括1例患者在骨搬移过程中出现软组织嵌顿,经软组织松解成形后痊愈;1例患者出现力线偏移,经外固定架调整后纠正;1例患者出现骨折延迟愈合,经自体髂骨植骨内固定后痊愈。结论环形外固定架骨搬移技术能够有效治疗胫骨中下段感染性骨不连,在术前设计、术中操作和术后处置等方面应充分结合手术部位的骨组织和软组织特点,积极处理好并发症。

Objective To explore the clinical effect of bone transport using circular external fixator to treat postoperative infectious nonunion of middle and lower tibia fracture.Methods A retrospective study was conducted on 19 patients with infectious nonunion of the middle and lower tibia who were treated in our department from January 2016 to December 2018.All patients were treated with debridement,one-stage segmental osteotomy and bone transport with external fixation.Of the 19 patients,16 male and 3 female were included,with average age of(46.2±11.8)years(range:37~62 years).We recorded operative time,number of operations,healing index,duration of implantation,length of bone extension,incidence of postoperative complications,and Baird-Jackson ankle function score and HSS knee function score in each cases.Results All 19 patients were followed up.The mean postoperative follow-up was(16.9±6.8)months.The operation times was(120.6±18.6)min,ranging from 100~150 min;average operation time was(1.2±0.4),ranging from 1~3 time;the average healing index was(39.4±8.2)d/cm,ranging from 31~52 d/cm;the average time with external fixator was(15.2±3.0)months,ranging from 12~21 months;the average length of bone transport was(7.2±2.2)cm,ranging from 4~11 cm.All patient obtained bony healing without reoccurred infection.The average Baird-Jackson ankle score was(83.4±7.1),ranging from 72~97;average HSS knee score was(89.2±5.4),ranging from 80~98.There were 1 case with soft tissue incarceration,and soft tissue release was conducted.1 case with shaft malformations,which was corrected after external fixator adjustment.1 case with nonunion after bone transport,which obtained bony union after internal fixation with autogenous iliac bone graft.Conclusion Infectious tibial nonunion treating with bone transport can obtain good clinical outcome.Preoperative design,intraoperative operation,and postoperative treatment,the characteristics of the bone tissue and soft tissue of the surgical site should be fully integrated to actively deal with complications.