Ilizarov短缩加压、再延长骨搬移术治疗创伤性股骨干骨缺损

Ilizarov technique with compression and distraction osteogenesis for treatment of traumatic femoral shaft defects

目的探讨Ilizarov短缩加压+再延长骨搬移术治疗创伤性股骨干骨缺损的临床疗效。方法采用回顾性病例系列研究分析2015年9月至2019年9月四川大学华西医院骨科收治的52例创伤性股骨干骨缺损患者临床资料,其中男32例.女20例;年龄19~60岁[(40.3±12.1)岁]。股骨干骨折部位:近1/3段15例,中1/3段20例,远1/3段17例。骨缺损类型:开放性骨折后骨缺损2例,感染性骨不连29例,萎缩性骨不连21例。清创截骨后骨缺损长度3.0~5.8 cm[(4.2±0.8)cm]。24例行I期直接断端短缩加压再延长术,28例行截骨短缩加压、II期在延长术(平均间隔时间2.8个月)。观察患者术后伤口创面愈合情况、骨性愈合时间、外固定指数(EFI)、术后并发症发生等情况:检测术前及术后白细胞计数(WBC)、C-反应蛋内(CRP)、红细胞沉降率(ESR)等。末次随访时采用Ilizarov方法与研究应用协会(ASAMI)评分标准对骨愈合及患肢功能恢复进行评价结果患者均获随访20~60个月[(36.5±10.3)个月]。伤口创面均I期愈合。骨性愈合时间9〜20个月[(14.5±3.8)个月]。EFI为1.2~1.9个月/cm[(1.5±0.2)个月/cm]。术后钉道感染14例(感染率27%);骨断端愈合不良1例;2例骨延长段出现轴向偏移,1例出现延长段矿化不良;2例术后患侧肢体较健侧分别短缩1.8cm、2.0 cm。末次随访时WBC[(6.0±1.4)×l0^(9)/L]、CKP[(6.8±1.7)mg/L]、ESR[(10.5±6.1)mm/h]较术前[(9.2±2.2)×l0^(9)/L、(31.7±22.l)mg/L、(45.8±31.3)mm/h]明显降低(P<0.01)。末次随访时ASAMI评分:骨愈合优31例,良13例,可8例,优良率为85%;患肢功能优28例,良14例,可7例,差3例,优良率为81%。结论Ilizarov短缩加压+再延长骨搬移术治疗创伤性股骨干骨缺损可彻底清除感染或缺血性骨病灶,通过牵张成骨技术完成断端持续加压促进断端愈合及肢体延长,实现肢体重建并促进骨性愈合和功能恢复。

Objective To investigate the clinical effect of Ilizarov technique with compression and distraction osteogenesis in treatment of traumatic femoral shaft defects.Methods A retrospective case series study was conducted to analyze the clinical data of 52 patients with traumatic femoral shaft defects admilted to West China Hospital of Sichuan University from September 2015 to September 2019,including 32 males and 20 females at age of 19-60 years[(40.3±12.1)years].There were 15 patients with fractures at the proximal 1/3,20 at middle 1/3 and 17 at distal 1/3 part of femoral shaft.Types of bone defects were bone defect after open fracture in 2 patients,infectious nonunion in 29 and atrophic nonunion in 21.Length of hone defects after debridement and osteotomy was 3.0-5.8 cm[(4.2±0.8)cm].A total of 24 patients underwent primary direct shortening and compression as well as re-lengthening of the broken ends;28 patients were operated by osteotomy and compression,and then by re-lengthening of the broken ends al II stage with the average interval of 2.8 months.Postoperative wound healing,bone healing time,external fixation index(EFI)and complications were observed.Preoperative and postoperative levels of white blood cell count(WBC),C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were measured.Association for the study and application of the method of Ilizarov(ASAMI)score was used to evaluate bone healing and functional recovery at the latest follow-up.Results All patients were followed up for 20-60 months[(36.5±10.3)months].All wounds were healed at I stage,with no infection or sinus tract recurrence.Bone healing time was 9-20 months[(14.5±3.8)months],and EFI was 1.2-1.9 months/c.m[(1.5±0.2)months/cm].Nail tract infection was found in 14 patients,wilh the infection rate of 21%.Poor healing of broken ends fracture occurred in 4 patients,out of which 3 with infectious nonunion and 1 with atrophic nonunion.Axial deviation was observed in 2 patients and poor mineralization was observed in 1 patient.In 2 patients,the affected side was shortened by 1.8 cm and 2.0 cm when compared to the healthy side.At the latest follow-up,levels of WBC[(6.0±1.4)×l0^(9)/L],CRP[(6.8±1.7)mg/L]andESR[(10.5±6.l)mm/h]were lower than those before surgery[(9.2±2.2)×l0^(9)/L,(31.7±22.1)mg/L,(45.8±31.3)mm/h](P<0.01).At the latest follow-up,bone healing rated on ASAMI score was excellent in 31 patients,good in 13 and fair in 8,with the excellent and good rate of 85%;limb function rated on ASAMI score was excellent in 28 patients,good in 14,fair in and good in 3,with the excellent and good rate of 81%.Conclusions For traumatic femoral shaft defects,Ilizarov technique with compression and distraction osteogenesis can fully remove infection or ischemic bone lesions.Distraction osteogenesis technology can complete continuous compression of broken ends to further promote healing of broken ends and limb lengthening and attain limb reconstruction and bone healing and functional recovery.