骨延长术和腓骨移植术治疗创伤性胫骨长段骨缺损的疗效分析

目的：探讨应用Ilizarov技术骨节段传送延长术（简称骨延长术）和带血管蒂腓骨移植结合Ilizarov环形外固定架固定术（简称腓骨移植术）治疗创伤性胫骨长段骨缺损的疗效。方法：按照骨缺损程度、软组织情况及实施带蒂组织瓣改善软组织条件，采用骨延长术和腓骨移植术对32例创伤性胫骨长段骨缺损进行治疗，参照Enneking系统对患肢进行功能评价，并分析2种治疗方法的骨性愈合时间、带外固定架时间、手术后患肢功能恢复程度。结果：随访时间10～52个月，平均36个月。骨延长术组和腓骨移植术组病例骨缺损均达到骨性愈合，平均骨性愈合时间分别为9．5、5．3个月，平均带外固定架时间分别为12、15个月，平均术后患肢功能恢复程度分别为74％、82％。结论：骨延长术治疗创伤性胫骨长段骨缺损具有缩短患者带架时间、减轻患者痛苦、可随时调整纠正畸形等优点，但术后问题较多，需密切随访，及时处理；Ilizarov环形外固定架固定牢靠，为移植腓骨骨愈合、早期功能锻炼创造了便利条件。

A comparison of the clinical effects of two operative methods for the treatment of traumatic massive bone defect of tibia

To compare with the clinical effects of treatment for traumatic massive tibial defect by Ilizarov bone transport technique and vascularized fibula grafting with Ilizarov fixator. Methods: Thirty cases of massive tibial defect,among wich 22 cases were repaired by Ilizarov bone transport technique and 10 cases were repaired by vascularized fibula grafting with Ilizarov fixator. the average postoperative follow-up was 36 months(from 10 to 52). Ilizarov bone transport group for the bone defec in 22 cases, the average bone defects was 6. 8 cm, and vascularized fibula grafting group in 10 case, the average bone defects was 8. 2 cm. The function of the operated limbs were evaluated according to Ennecking Score System. Results: The bone defect was filled up and the length discrepancy of the extremity was corrected. Bony healing was obtained in all cases, The average time to union was 9. 5 months in bone transporting group and 5. 3 months in fibula grafting group. The average time of external fixation was 12 months in bone transporting group and 15 months in fibula grafting group. Conclusions: The two operation techniques can be used to repaire traumatic massive tibial defect, and clinical effective no obvious difference. The Ilizarov fixation provide a convenience condition for fibula graft.