单边外固定支架骨搬运治疗胫骨大段骨缺损的疗效分析

Bone transport with unilateral external fixation for treatment of massive tibial bone defects

目的探讨单边外固定支架骨搬运治疗胫骨大段骨缺损的疗效。方法回顾性分析2017年2月至2022年1月赣州市人民医院创伤急救中心创伤骨科采用单边外固定支架骨搬运术治疗21例胫骨大段骨缺损患者资料。男14例,女7例;年龄(46.3±11.3)岁。骨缺损原因:外伤骨缺损5例,外伤骨不连硬化骨切除9例,骨感染切除6例,骨肿瘤切除1例。骨缺损长度为(8.3±1.7)cm。术后10~12 d开始搬运骨段,搬运速度1 mm/d,分4次完成,每2周复查X线片,随访记录骨愈合时间、外固定支架戴架时间(EFT)、外固定支架指数(EFI)、对接端处理情况和并发症情况,末次随访时采用Paley评分评估疗效。结果所有患者术后均获随访,随访时间为(13.5±5.5)个月。本组患者的新生骨均矿化良好,骨愈合时间为(9.6±2.2)个月;EFT为(10.3±4.0)个月;EFI为(1.3±0.4)个月/cm。对接端均愈合,行对接端清理者14例,其中单纯外固定支架加压5例,对接端植骨者9例。术后钉道感染6例,胫骨力线偏移1例,足下垂畸形5例,马蹄内翻足畸形1例,足趾屈曲畸形3例,1例拆除外固定支架后矿化区再骨折。末次随访时患者的Paley评分骨性结果:优16例,良5例;功能结果:优10例,良7例,一般4例。结论单边外固定支架骨搬运术是治疗胫骨大段骨缺损的有效方法,具有操作简单、携带方便等优点。

Objective To analyze the clinical efficacy of bone transport with unilateral external fixation in the treatment of massive tibial bone defects.Methods A retrospective study was conducted to review the 21 patients with massive tibial bone defects who had been treated by bone transport with unilateral external fixation from February 2017 to January 2022 at Department of Trauma Orthopedics,Ganzhou People's Hospital.There were 14 males and 7 females with a mean age of(46.3±11.3)years.Causes for bone defects:trauma(n=5),resection of bone non-union(n=9),resection of infected bone(n=6)and resection of bone tumor(n=1).The mean bone defect length was(8.3±1.7)cm.Bone transport started from 10 to 12 days after operation,with a speed of 1 mm/d,and was completed in 4 times.X-ray films were reviewed every 2 weeks.The bone union time,external fixation time(EFT),external fixation index(EFI),docking site situation and complications were recorded.The clinical efficacy was assessed by Paley score.Results All patients were followed-up for a mean time of(13.5±5.5)months.The mineralization of regenerated bone was good.The bone union time was(9.6±2.2)months,the EFT(10.3±4.0)months,and the EFI(1.3±0.4)months/cm.All docking sites got united.The docking sites were cleaned in 14 patients,of whom simple compression with external fixation was performed in 5 and bone grafts at the docking sites in 9.Postoperative nail tract infection was observed in 6 cases,tibial alignment deviation in 1 case,foot drop deformity in 5 cases,horseshoe varus foot deformity in 1 case,toe flexion deformity in 3 cases,and refracture after removing the external fixation in 1 case.By the Paley score,the bony outcomes were rated as excellent in 16 and as good in 5 cases.The functional outcomes were excellent in 10,good in 7,and acceptable in 4.Conclusion Bone transport with unilateral external fixation is an effective treatment for massive tibial bone defects,showing advantages of easy operation and convenient carry.