"手风琴"技术在骨搬移治疗胫骨骨缺损中促进对合端骨愈合的疗效分析

"Accordion" technique to promote bony union at the docking site in the treatment of tibial bone defects by Ilizarov technique

目的:探讨"手风琴"技术在骨搬移治疗胫骨骨缺损过程中促进对合端骨愈合的疗效。方法:回顾性分析2017年11月至2019年2月期间山西医科大学第二医院骨科收治的11例胫骨骨感染患者资料。男10例,女1例;年龄(47.0±9.7)岁。其中7例为开放性骨折内固定或外固定术后感染,4例为闭合性骨折内固定术后感染。手术行清创,敏感抗生素骨水泥置入,根治性切除死亡或感染的骨段后,所有患者骨缺损长度为(6.6±2.9)cm,采用Ilizarov环形外固定支架进行骨搬移治疗。所有患者在搬移骨块与对合端接触后采用"手风琴"技术治疗。记录骨搬移过程中的对合时间、"手风琴"技术治疗时间、愈合时间以及骨搬移期间的并发症发生情况。结果:所有患者均未在对合端进行植骨。所有患者术后随访(2.7±0.5)年。对合时间为(30.8±6.8)周,"手风琴"技术治疗时间为(43.1±8.4)d,愈合时间为(31.6±9.0)周。所有患者均无明显疼痛,3例患者出现踝关节僵硬,1例患者出现创伤性马蹄足畸形。结论:在Illizarov方法基础上使用"手风琴"技术,可以加速搬移骨段矿化,促进对合端骨愈合,无需手术植骨,可有效解决胫骨骨缺损。

Objective To evaluate the effect of"accordion"technique on promoting bony union at the docking site in the treatment of tibial bone defects by bone transport.Methods A retrospective study was conducted to analyze the data of 11 patients with tibial bone infection who had been admitted to Department of Orthopedics,The Second Hospital of Shanxi Medical University from November 2017 to February 2019.There were 10 males and 1 female with an age of(47.0±9.7)years.Seven patients were infected after internal/external fixation for open fractures and 4 cases after internal fixation for closed fractures.After surgical debridement,sensitive antibiotic bone cement was implanted,and dead or infected bone segments were radically resected.In all patients,the resulting bone defects of(6.6±2.9)cm were fixated by an Ilizarov ring external fixator and filled by bone transport.The"accordion"technique was used after the bone segments touched the docking site.The closure time,"accordion"time,bony union time and complications during bone transport were recorded.Results None of the patients underwent bone grafting.This case series was followed up for(2.7±0.5)years.The closure time was(30.8±6.8)weeks,the"accordion"time(43.1±8.4)days,and the bony union time(31.6±9.0)weeks.None of the patients had obvious pain.Ankle stiffness was observed in 3 patients and traumatic equinus deformity in 1 patient.Conclusions The"accordion"technique based on the Illizarov technique can accelerate mineralization of the bone segments transported,promote the bony union at the docking site,and effectively solve the problem of tibial bone defects without surgical bone grafting.