半侧骨段纵向搬移技术治疗下肢长骨感染性半侧骨段缺损的临床观察

Hemilateral bone longitudinal transport technique for the treatment of hemilateral defects of long bones of lower limbs

目的:探讨采用半侧骨段纵向搬移技术治疗下肢长骨感染性半侧骨段缺损的临床疗效。方法:回顾性分析2009年6月至2019年12月采用半侧骨段纵向搬移技术治疗的13例下肢长骨感染性半侧骨段缺损患者的临床资料,其中男10例,女3例;年龄14~55岁;股骨4例,胫骨9例;创伤性骨髓炎10例,血源性骨髓炎3例。13例患者的骨髓炎Cierrny-Mader解剖分型均为Ⅲ型局限型。观察患者骨愈合、创面愈合、术后并发症及关节活动度情况。采用Paley评价标准观察骨性结果和功能结果。结果:所有患者拆除外固定架后均获得随访,时间6~70个月,搬移时间54~158 d,带架时间6.8~19.5个月,外固定指数每厘米1.23~1.60个月。根据Paley评价标准:骨性结果,优13例;功能结果,优12例,良1例。2例患者对合端愈合不良,经自体髂骨植骨后愈合;1例患者延长部位骨痂矿化欠佳,应用低强度脉冲超声波治疗后愈合;所有患者创面愈合良好,无骨髓炎复发,无再骨折发生,均未出现血管神经损伤及轴向偏移,均对下肢外观及功能满意。术前膝、踝关节活动度分别为120°~150°、35°~80°,末次随访时分别为110°~140°、30°~75°。结论:半侧骨段纵向搬移技术治疗下肢长骨感染性半侧骨段缺损的疗效确切,可简化外固定架构型,减少固定针数,降低针道感染发生率,减短外固定架佩戴时间,但该术式技术要求较高,且需注意延长区骨痂生长及对合端骨愈合问题。

Objective To explore clinical efficacy of Ilizarov hemilateral bone longitudinal transport technique in treating hemilateral bone defects associated with chronic osteomyelitis of lower extremity long bones.Methods Clinical data of 13 patients with hemilateral bone defects caused by chronic osteomyelitis of lower extremity long bones and treated by Ilizarov hemilateral bone longitudinal transport technique were retrospective analyzed,including 10 males and 3 female,aged from 14 to 55 years old;4 patients occurred femoral and 9 patients occurred tibial;10 patients were diagnosed as traumatic osteomyelitis and 3 patients as hematogenous osteomyelitis.The anatomical classification of Cierny-Mader in 13 patients was typeⅢ.Bone and wound healing,postopertaive complication,and bony and functional results were observed by Paley evaluation standard.Results After removing external fixator,all patients were followed up from 6 to 70 months.Transporting time ranged from 54 to 158 d.And the time in external fixation ranged from 6.8 to 19.5 months.External fixation index(EFI)ranged from 1.23 to 1.6 months/cm.According to Paley's evaluation criteria,bony results were excellent in 13 patients;functional results showed excellent in 12 patients and good in 1 patient.Two patients occurred poor union on the docking sites and healed with autogenous iliac bone graft.The callus at the extended area was poorly mineralized and improved significantly when treated with lowintensity pulsed ultrasound in one patient.All patients had good wound healing without recurrence of osteomyelitis and refracture.There was no vascular and nerve injury and axial deviation in all patients and they were satisfied with the appearance and function of lower limbs.The range of motion of knee and ankle joint before operation was 120°to 150°and 35°to 80°respectively,and at the latest followup was 110°to 140°and 30°to 75°.Conclusion Ilizarov hemilateral bone longitudinal transport technique is effective in treating infective hemilateral bone defects of lower extremity long bones,which could not only simplify architecture of external fixation,but also reduce the number of fixation pins,shorten the time in external fixator and decrease the incidence of pin tract infection.However,this technique is highly demanding,and the growth of callus in extended region and healing of bone apposition should be noticed.