外固定架结合骨段滑移治疗胫骨骨折

目的探讨利用外固定架结合骨段滑移治疗胫骨骨折的方法。方法应用外固定架结合骨段滑移的方法治疗11例胫骨骨折合并骨缺损和软组织缺损的患者。胫骨缺损长度4～12 cm;软组织缺损面积4 cm×5cm～8 cm×16 cm。使用单边重建外固定架,经过扩创、清除死骨、骨膜下截骨、骨段滑移、骨接触端植骨等步骤完成骨段滑移。结果 11例均获随访,时间18～48个月。胫骨骨折均获得愈合。骨段滑移5～12(8±1.9)cm。4例出现钉道浅表感染。2例膝关节屈伸活动度较健侧减少15°,1例踝关节屈伸减少10°,但是不影响生活。2例进行了浅表创面游离植皮。无经历第二次深部扩创、无进行皮瓣转移。结论外固定架结合骨段滑移是治疗胫骨骨折、骨缺损的有效办法,具有创伤小、疗效确切的优点。

Treatment of complex tibia fracture with bone transport and external fixator

Objective To evaluate the effect of bone transport on managing complex tibia fracture with external fixator.Methods 11 patients with the anterior-medial side of complicated injured legs were treated by external fixator of lower limb reconstruction system.The length of tibial defect was 4~12 cm,the largest skin loss area on the anterior-medial side of the leg was 8 cm×16 cm,and the smallest area was 4 cm×5 cm.Bone transport was completed with the treatment of single-side external fixators through wond reconstruction,sequestrectomy,bone cutting,bone transport.Results 11 cases were followed up for 18~48 monthes.superficial infection was appeared in 4 cases that healed with dressing and washing the wound.Two cases had knee flexion deformity and the range of motion decreased by 15° compared with the contralateral knee joint.In 1 case ankle flexion and extension was reduced by 10° but without obvious discomfort.Two cases had superficial wound skin grafting with no flap.All the wounds of patients healed with no flap and secondary debridement.Conclusions Bone transport with external fixator can be used as effective and satisfactory method to manage complex tibia fracture.It is also safe and minimally invasive.