两种应用Ilizarov技术治疗胫骨大段骨合并软组织缺损的疗效分析

Two methods of Ilizarov technique in the treatment of large tibial bone defects with soft tissue defect

目的探讨两种应用Ilizarov技术治疗胫骨大段骨合并软组织缺损的临床效果。方法选取2015年1月-2019年1月收治的胫骨大段骨合并软组织缺损患者32例,随机分成两组,每组16例。A组采取Ilizarov骨搬运技术联合VSD、皮瓣修复治疗;B组清创术后直接采取Ilizarov骨搬运技术治疗。术后随访18~36个月,比较两组患者的骨及软组织愈合时间、并发症发生情况、骨折愈合质量以及术后患肢功能恢复情况。结果骨缺损愈合时间A组平均为8.6个月,B组为11.7个月;软组织缺损处愈合时间A组平均为2.1个月,B组3.6个月;A组在骨及软组织愈合时间上均明显短于B组,差异有统计学意义(P<0.05);B组出现并发症的例数明显多于A组,尤其在钉道感染及疼痛这两方面上,差异有统计学意义(P<0.05);采用Paley评价标准对两组患者的骨折愈合质量进行评价,A组骨折愈合优良率为93.75%,明显高于B组的81.25%,差异有统计学意义(P<0.05);采用Johner-Wruhs评分系统对患肢功能进行评价,A组患肢功能恢复优良率为87.50%,明显高于B组的81.25%,差异有统计学意义(P<0.05)。结论应用Ilizarov技术治疗胫骨大段骨合并软组织缺损是一种理想方法,同时重视创面修复,能取得更显著的临床效果。

Objective To comparie the effect of two methods of using Ilizarov technique in the treatment of large tibial bone defects with soft tissue defect.Methods Selected 32 cases of patients with large tibial bone defects combined with soft tissue defect in our hospital,treated time was from March 2015 to September 2019,randomly divided into two groups,each group had 16 cases.Group A was used Ilizarov technology combined with VSD,flap repair treatment;group B was directly taken Ilizarov technical treatment after debridement.Followed up for 12-24 months,an average of 17.5 months,compared the two groups of patients with bone and soft tissue healing time,complications,fracture healing quality and postoperative limb function recovery.Results The bone healing time of group A was average of 8.6 months,group B was average of 11.7 months;And the healing time of soft tissue defects was average of 2.1 months in A group,group Bwas average of 3-6 months.Group A in the healing time of bone and soft tissue defects was significantly shorter than group B,the difference was statistically significant(P<0.05).The number of complications in group B was significantly higher than that in group A especially in two aspects of nail tract infection and pain,the difference was statistically significant(P<0.05);the quality of fracture healing of two groups was evaluated by Paley criteria,the excellent rate of fracture healing in group A was 93.75%,which was significantly higher than that in group B(81.25%).The difference was statistically significant(P<0.05);the rate of limb function was evaluated by Johner-Wruhs score,and the rate of limb function recovery in group A was 87.50%,which was significantly higher than that in group B(75.00%),and the difference was statistically significant(P<0.05).Conclusions Compared with the direct application of Ilizarov technology,Ilizarov technology combined with flap,VSD technology to control infection,repair the wound,do better in the efficacy,complications and the limb function recovery in the treatment of large tibial bone defect with soft tissue defect,and this method is worth promoting.