骨搬移术治疗尺桡骨感染性骨缺损的疗效观察

Clinical effect of bone transport in treatment of infected bone defects of radius or ulna

目的探讨骨搬移术治疗尺桡骨感染性骨缺损的临床疗效。方法回顾性分析自2010-01—2017-12采用骨搬移术治疗的16例尺桡骨感染性骨缺损,术中清创并切除感染骨段,采用环式外固定架固定,确定截骨平面后行骨膜下截骨,术后沿着骨轴线向缺损处持续牵张。结果 16例均顺利完成手术并获得完整随访,随访时间24~36个月,平均30.0个月。未出现重要神经及血管损伤,2例出现对接端骨段轴向偏移,2例出现钉道感染,3例创面无法直接愈合,均经对症处理后治愈。外固定支架固定时间7~15个月,平均8.9个月。对接端骨愈合时间3~14个月,平均7.5个月。末次随访时前臂关节活动度:腕屈曲40°~55°,平均52.1°;腕背伸40°~60°,平均46.6°;肘屈曲135°~150°,平均141.6°;肘伸展0°~10°,平均4.7°;前臂旋前55°~85°,平均74.7°;前臂旋后65°~90°,平均80.6°。结论骨搬移术治疗尺桡骨感染性骨缺损具有骨量需求小、抗感染能力强、可同时修复软组织缺损等优势,临床疗效满意。

Objective To explore the clinical effect of bone transport in the treatment of infected bone defects of radius or ulna.MethodsSixteen cases of infected bone defects of radius or ulna treated by bone transport from January 2010 to December2017 were retrospectively analyzed. After complete debridement and resection of the infected bone segment, the ring external fixator was used, after determining the osteotomy plane, subperiosteal osteotomy was performed. All cases underwent bone transport along the bone axis after operation.ResultsAll 16 cases successfully completed the operation and obtained complete follow-up. The follow-up time was 24 to 36 months, with an average of 30.0 months. No major nerve or blood vessel injuries occurred, but 2 cases had axial offset at the docking site, 2 cases had pin tract infection, and 3 cases had wound that could not closed directly, all of which were cured after symptomatic treatment. The external fixator time was 7-15 months, with an average of 8.9 months. The bone healing time at the butt end was 3-14 months, with an average of 7.5 months. Forearm range of motion at the last follow-up was wrist flexion 40°-55°, average 52.1°;wrist dorsal extension 40°-60°, average 46.6°;elbow flexion135°-150°, average 141.6°;elbow extension 0°-10°, average 4.7°;forearm pronation 55°-85°, average 74.7°;forearm supination 65°-90°, average 80.6°.ConclusionBone transport in repairing infected bone defects of radius or ulna can achieve satisfactory results with the advantages of less bone grafting demand, strong anti-infection ability, and can repair soft tissue defects at the same time.