骨短缩-延长肢体治疗下肢开放性粉碎性骨折临床疗效分析

The clinical efficacy of using Orthofix unilateral external fixation through bone shortening-lengthening in the treatment of open comminuted fractures of lower limbs

目的 探讨使用Orthofix单边外固定架通过骨短缩-延长肢体治疗下肢开放性粉碎性骨折临床疗效。方法 回顾性分析2017年1月~2022年3月深圳市龙华区中心医院创伤骨科使用Orthofix单边外固定架通过骨短缩-延长肢体治疗下肢开放性粉碎性骨折患者25例,男性18例,女7例,年龄20~57岁,平均38.6岁,股骨8例,胫骨17例,左侧14例,右侧11例,GustiloⅢC型5例,GustiloⅢB型20例,交通事故17例,重物砸伤8例,2例合并2型糖尿病,合并软组织缺损23例,合并大动静脉缺损3例(缺损长度分别为9 cm, 5 cm, 4 cm),合并踝关节骨折5例。所有病例经清创后出现骨缺损,骨缺损长度5~23 cm,平均缺损长度10 cm,软组织缺损面积8 cm×5 cm~18 cm×10 cm。GustiloⅢC型患者根据缺损动静脉长度进行相应长度骨短缩并用组合式外固定架固定,直接闭合创面或封闭负压引流。GustiloⅢB型患者一期骨短缩3~7 cm并用组合式外固定支架固定,创面直接闭合或封闭负压引流,合并大动静脉缺损患者1.5月后安装Orthofix单边外固定架,并行股骨或胫骨截骨延长术,未合并大动静脉缺损患者术后1周左右复查白细胞计数、中性粒细胞计数、C反应蛋白及降钙素原正常后,安装Orthofix单边外固定架+股骨或胫骨截骨延长术。结果 随访12~36个月,所有患者骨及软组织缺损均愈合,未出现下肢不等长>2.5 cm、骨延长区域或骨折端再发骨折等并发症。骨性愈合时间为12~24个月,平均18.6个月;骨性愈合指数为31.7~120.2 d/cm,平均63.8 d/cm;外固定时间为12~30个月,平均20.6个月;外固定指数为32.3~117.2 d/cm,平均56.8 d/cm。Ilizarov技术研究与应用学会(Association for Study and Application of Method of Ilizarov, ASAMI)骨愈合评价:优23例,良2例;ASAMI下肢功能评价:优17例,良7例,可1例。结论 使用Orthofix单边外固定架通过骨短缩-延长肢体治疗下肢开放性粉碎性骨折可同时修复骨与软组织缺损,无须移植血管神经及皮瓣修复,降低手术难度,值得临床推广。

Objective To investigate the clinical efficacy of using Orthofix unilateral external fixation through bone shortening-lengthening in the treatment of open comminuted fractures of lower limbs.Methods Retrospective analysis was carried out in 25 patients hospitalized in Department of Traumatic Orthopaedics,Longhua District Central Hospital of Shenzhen from January 2017 to March 2022.They were 18 males and 7 fe-males,aged 38.6(20~57)years,with 8 femoral and 17 tibial,14 left and 11 right,treated with Orthofix u-nilateral external fixator through bone shortening-lengthening for open comminuted fractures of lower limbs.There were GustiloⅢC of 5 cases,GustiloⅢB of 20 cases,with type 2 diabetes of 2 cases,soft tissue defect of 23 cases,large arteriovenous defect of 3 cases(with defect length of 9 cm,5 cm,4 cm re-spectively).They had 10(5~23)cm bone defect in all cases after debridement,and the soft tissue de-fects ranged from 8 cm×5 cm to 18 cm×10 cm.To Gustilo typeⅢC patients,the bone was shortened ac-cording to the length of the artery and vein and fixed with a combined external fixation,followed by di-rect closure of the wound or vacuum sealing drainage.To Gustilo typeⅢB patients,it was used of the acute bone shortening of 3~7 cm fixed with a combined external fixation and direct closure of the wound or vacuum sealing drainage.Patients with large arteriovenous defects underwent femoral or tibial osteoto-my lengthening with Orthofix unilateral external fixators after 1.5 months,and patients without large arteri-ovenous defects underwent femoral or tibial osteotomy lengthening with Orthofix unilateral external fixators about 1 week after surgery if their white blood cell count,neutrophil count,C-reactive protein and calci-toninogen were normal.Results All patients were followed up for 12~36 months.All patients'bone and soft tissue defects healed without any lower limb inequality>2.5 cm or complications such as re-frac-ture of the bone lengthening area or fracture ends.The bone healing time ranged from 12 to 24 months,with an average of 18.6 months;the bone healing index ranged from 31.7 to 120.2 d/cm,with an average of 63.8d/cm;the external fixation time ranged from 12 to 30 months,with an average of 20.6months;the external fixation index ranged from 32.3 to 117.2 d/cm,with an average of 56.8d/cm.ASAMI bone healing e-valuation showed excellent in 23 cases,good in 2 cases.The functional evaluation of the lower limb of ASAMI showed excellent in 17 cases,good in 7 cases and moderate in 1 case.Conclusion The use of Orthofix uni-lateral external fixator for open comminuted fractures of the lower limbs by bone shortening-lengthening method can repair both bone and soft tissue defects without the need for vascular nerve grafting or skin flap repair,which reduces the difficulty of surgery and is worthy of clinical promotion.