可调组合环小腿同步延长器治疗胫骨感染骨缺损的临床疗效观察

目的 研究可调组合环小腿同步延长外固定器治疗胫骨感染骨缺损的临床效果、安全性及意义,同时研究诱导型一氧化氮合酶与骨质再生的关系来探讨骨延长的分子生物学机制.方法 选择胫骨干骨折继发严重下肢感染而引起胫骨缺损行外固定器固定及截骨延长骨搬移术患者28例（研究组）,选择20例健康体检者为对照组,研究组于不同时间点测定血清诱导型一氧化氮合酶水平并与对照组进行比较.结果 研究组所有患者均达到预定的骨延长长度,骨缺损得到修复并达到骨性愈合.所有标本细菌培养结果均为阳性,其中18例（64.29％,18/28）为耐药金黄色葡萄球菌,5例（17.86％,5/28）为溶血性链球菌,2例（7.14％,2/28）为铜绿假单胞菌,1例（3.57％,1/28）为耐药阴沟杆菌,1例（3.57％,1/28）为表皮葡萄球菌,1例（3.57％,1/28）为洋葱样胞菌,前二者所占的比例显著高于其他细菌,差异有统计学意义（P＜0.05）.研究组术后第1天血清诱导型一氧化氮合酶水平开始增高,但与对照组比较差异无统计学意义（P＞0.05）;研究组术后第14天血清诱导型一氧化氮合酶水平与对照组比较差异有统计学意义[（118.8±6.6） U/L比（86.4±5.4） U/L]（P＜ 0.05）;研究组停止延长时血清诱导型一氧化氮合酶水平达到高峰,且与对照组比较差异有统计学意义[（136.2±8.4） U/L比（88.2±3.6） U/L]（P＜ 0.05）;研究组停止延长后血清诱导型一氧化氮合酶水平逐渐下降,停止延长后第1天和第3天与对照组比较差异有统计学意义[（132.6 ±9.0） U/L比（87.6±4.8） U/L、（103.8±5.4） U/L比（86.4±4.2） U/L]（P＜ 0.05）;研究组其余时间点与对照组比较差异无统计学意义（P＞0.05）.结论 外固定器对于胫骨缺损患者的修复与功能重建作用可达到预期治疗目标;骨延长时血清诱导型一氧化氮合酶的表达增高提示其可能为骨质再生的分子生物学机制之一.

The clinical effect of treatment with external circular fixator in bone defect after tibial shaft fractures secondary infection

Objective To analyze the clinical effectiveness,safety and significance of treatment with external circular fixator,through the relationship of inducible nitric oxide synthase （iNOS） and bone regeneration to further explore the mechanism of the molecular biology of bone lengthening at the same time.Methods Collected bone defect after tibial shaft fractures secondary infection who were treated with external circular fixator as study group （28 cases）,all the cases fixed by external circular fixator,20 healthy volunteers as control group.Study group in different time point measured the levels of serum iNOS content,were compared with the control group.Results All patients were scheduled to reach the extremity lengthening and the bone defect were repaired and healed in study group.The bacterial culture results showed that 18 cases （64.29％,18/28） of resistant Staphylococcus aureus,5 cases （17.86％,5/28） of Hemolytic streptocaccus,2 cases （7.14％,2/28） ofP.aeruginosa,one case （3.57％,1/28） of drug-resistant Enterobacter cloacae,one case（3.57％,1/28） of Staphylococcus epidermidis,one case（3.57％,1/28） of Onion-like aeromonas,the proportion of the former two was significantly higher than other bacteria （P ＜ 0.05）.The levels of serum iNOS content 1 d after surgery in study group were increased,compared with control group,difference was no significant （P ＞ 0.05）.The levels of serum iNOS content 14 d after surgery,stoped extend,1 d stoped extend,3 d stoped extend in study group were significantly higher than those in control group [（118.8 ± 6.6） U/L vs.（86.4 ± 5.4） U/L,（136.2 ± 8.4） U/L vs.（88.2 ± 3.6） U/L,（132.6 ± 9.0） U/L vs.（87.6 ± 4.8） U/L,（103.8 ± 5.4） U/L vs.（86.4 ± 4.2） U/L] （P ＜ 0.05）,there was no significant difference between two groups in other times （P ＞ 0.05）.Conclusions External circular fixator for the repair and reconstruction effects in patients with bone defect can achieve the desired therapeutic goal,the higher expression of iNOS may be one of the molecular biological mechanisms of bone lengthening.