计算机辅助六轴外固定器骨搬移术治疗GustiloⅢ型开放性胫骨骨折伴节段性骨缺损

Computer-assisted hexapod spatial frame transport for Gustilo gradeⅢopen tibial fractures combined with segmental bone defects

目的:探讨应用计算机辅助六轴外固定器进行骨搬移术治疗GustiloⅢ型开放性胫骨骨折伴节段性骨缺损的临床疗效及技术要点。方法:回顾性分析2019年8月至2022年2月使用计算机辅助六轴外固定器进行骨搬移术治疗的28例开放性胫骨骨折伴节段性骨缺损患者的临床资料,男19例,女9例,年龄19~70岁,平均年龄(48.4±13.9)岁。所有病例均为GustiloⅢ型开放性胫骨骨折,骨缺损的长度为5.1~17.2 cm,平均(9.3±3.1)cm。其中11例伴有骨感染,15例伴有软组织缺损,软组织缺损的面积为30~240 cm2,平均(78.8±55.4)cm^(2)。所有病例均为胫骨中段或远端骨缺损,采用胫骨近端截骨向远端搬移。计算骨延长指数(LI),进行Ilizarov技术研究会与应用学会(ASAMI)骨与下肢功能评价,同时观察并发症发生情况。结果:28例患者均获得随访,随访时间为15.7~45.3个月,平均(32.1±8.1)个月。所有病例均骨性愈合。外固定器佩带时间为6.6~15.3个月,平均(9.7±2.2)个月。LI为0.7~1.6月/厘米,平均(1.1±0.2)月/厘米。ASAMI骨评价结果显示:优27例,良1例,可0例,差0例;优良率100%(28/28)。ASAMI下肢功能评价结果显示:优23例,良4例,可1例,差0例,失败0例;优良率96.5%(27/28)。4例患者发生针道感染,1例患者拆除外固定器后出现了对合端局部软组织破溃,1例患者出现马蹄内翻足畸形。结论:计算机辅助六轴外固定器进行骨搬移术是治疗GustiloⅢ型开放性胫骨骨折伴节段性骨缺损的有效方法,骨延长愈合快,骨与下肢功能评价好。六轴外固定器数字化外固定技术可以精准调节骨搬移过程中的机械轴偏移和对合端的移位、成角、旋转畸形。

Objective:To explore the clinical efficacy and technical key points of computer-assisted hexapod spatial frame bone transport in the treatment of Gustilo gradeⅢtibial open fractures with segmental bone defects.Methods:A retrospective analysis was conducted on the clinical data of 28 patients with open tibial fractures and segmental bone defects treated with hexapod spatial frame from August 2019 to February 2022.Among them,there were 19 males and 9 females,with an age range of 19 to 70 years and an average age of(48.4±13.9)years.All cases were Gustilo gradeⅢopen fractures,with a bone defect length ranging from 5.1 cm to 17.2 cm,with an average of(9.3±3.1)cm.Among them,11 cases were accompanied by bone infection,and 15 cases had soft tissue defects,with a soft tissue defect area ranging from 30 cm2 to 240 cm^(2)and an average of(78.8±55.4)cm2.All cases had midshaft or distal tibial bone defects and underwent proximal tibial osteotomy for transport to the distal end.The bone lengthening index,Association for the Study and Application of the Method of Ilizarov(ASAMI)bone and lower-limb functional score and the occurrence of complications were observed.Results:The follow-up period for the 28 patients ranged from 15.7 to 45.3 months,with an average of(32.1±8.1)months.All cases achieved osseous union.The duration of frame application ranged from 6.6 to 15.3 months,with an average of(9.7±2.2)months.The bone lengthening index ranged from 0.7 to 1.6 months/cm,with an average of(1.1±0.2)months/cm.The ASAMI bone evaluation results showed that excellent in 27 cases,good in 1 case,fair in 0 case,and poor in 0 case,with an excellent/good rate of 100%.The ASAMI lower limb functional assessment results showed that excellent in 23 cases,good in 4 cases,fair in 1 case,poor in 0 case and failure in 0 case,with an excellent/good rate of 96.5%.Four cases experienced pin tract infection,one case had local soft tissue breakdown after frame removal,and one case developed equinovarus deformity of the foot.Conclusions:Computer-assisted hexapod spatial frame bone transport is an effective method for treating Gustilo gradeⅢtibial open fractures with segmental bone defects.It can successfully salvage limbs on the verge of amputation,achieve rapid bone healing,and provide good bone and functional evaluation.The hexapod spatial frame has a simple configuration and provides stable fixation.This digital external fixation technology allows precise adjustment of mechanical axis deviation,displacement,angulation,and rotational deformities during the bone transport process.