胫骨骨运输术中对接端新鲜化技术的临床观察

Effect of freshening technique on docking site in tibial bone transport management

目的:研究胫骨骨运输术中对接端应用骨面新鲜化处理技术的效果。方法:对2014年1月至2019年12月胫骨骨运输术中对接端骨面新鲜化处理手术的20例患者进行分析。其中男15例,女5例;年龄19~62(42.3±11.5)岁;感染性7例,非感染性13例。对接端达到接触后即刻通过使骨面新鲜化处理的手术技术,清除卡入断端的皮肤和软组织,切除硬化封闭的骨端,改善对位,增加接触面积,术中即刻对对接端进行加压,并就近取骨植骨。术后继续逐渐加压。结果:缺损长度5~15(9.2±2.9)cm,从截骨到对接端接触需要26~243(109.1±51.1)d。所有患者对接端达到骨性愈合。达到影像学愈合标准需要3~7(3.7±1.1)个月,20例中15例需要腓骨截骨,其中14例腓骨的截骨端达到骨性愈合。胫骨牵开端的骨痂达到影像学坚实化的时间需要5~28(15.0±6.5)个月,骨愈合指数(bone healing index,BHI)为每厘米需0.8~2.8(1.6±0.5)个月。20例中1例胫骨切口出现感染。拆除外固定架后随访时间为12~73(37.6±20.3)个月,所有患者对接端未发生骨折。结论:胫骨骨运输术中,当对接端接触后尽早进行骨面新鲜化处理能缩短对接端的愈合时间,避免对接端再骨折,术中收集的松质骨和钻孔产生的骨屑能消除缺损和间隙,避免在其他部位取自体骨植骨。

Objective:To study the effect of freshening technique on docking site in tibial bone transport management.Methods:Retrospective cohort study was conducted about the effect of freshening technique on docking site in 20 cases(15 males and 5 females)treated with tibial bone transport from January of 2014 to December of 2019.The age of patients ranged from 19 to 62 years old,with an average of(42.3±11.5)years old.Seven patients had infectious bone defect and 13 patients had non-infectious.Application of freshening technique immediately after docking included resection of invaginated skin or soft tissue,removal of closed sclerotic bone,re-apposition,increasing the contact,acute compression of freshened docking site and grafting from adjacent medullary or bone debris,followed by post-operative gradual compression.Results:The amount of segmented bone defect ranged from 5 to 15 cm,with an average of(9.2±2.9)cm.Time required from osteotomy to contact of butt end ranged from 26 to 243 days,with an average of(109.1±51.1)days.The duration needed from 3 to 7 months with an average of(3.7±1.1)months before reaching radiological healing criterion in docking site.Fourteen out of 15 concurrent fibular osteotomy were united.Consolidation time for distracted callus ranged from 5 to 28 months,with an average of(15.0±6.5)months.Bone healing index(BHI)ranged from 0.8 to 2.8 months/cm,with an average of(1.6±0.5)months.One surgical site infection(5%)in tibial was noted.No refractures were found in follow-up ranged from 12 to 73 months,with an average of(37.6±20.3)months after fixator removal.Conclusion:Freshening technique immediately after docking had advantages of the shorter healing time,avoidance of refracture,and independance of necessity for remote autograft harvest.