双处截骨纵向搬移治疗长段小腿感染性复合缺损

目的探讨胫骨双处截骨纵向搬移治疗胫骨干大段感染性骨缺损复合软组织缺损的疗效及并发症情况。方法回顾性分析2009年5月至2016年5月收治的31例胫骨干大段感染性骨缺损复合软组织缺损资料,男27例,女4例,年龄2~58岁,平均33.4岁。胫前软组织缺损面积7 cm×8 cm~24 cm×12 cm,胫骨缺损长度6.5 cm~18.2 cm,平均11.4 cm。术后随访时间1~8年,平均32个月。随访观察骨及软组织愈合和并发症情况。结果31例感染均愈合,骨缺损及软组织缺损创面全部愈合。4例出现骨断端延迟愈合,植骨后愈合,3例出现骨延长区伤口感染及成骨不良,经放置万古霉素骨水泥棒2个月及"手风琴"技术处理后愈合;其余骨缺损与软组织创面均顺利愈合。软组织愈合时间为65 d~190 d,平均70 d,骨愈合的时间为14~35个月,平均21.6个月;28例患者肢体长度完全恢复,3例患者患肢较健侧短1.5 cm。结论对于8 cm以上的胫骨骨与软组织复合缺损,双处截骨纵向搬移可缩短治疗时间。主要并发症为骨会师端延迟愈合、成骨不良和胫骨力线偏移,经处理后恢复正常。

Bifocal corticotomy and bone transport for large segmental composite defects of the leg

Objective To evaluate the treatment effects and complications of the bifocal corticotomy of bone transport technique for long defects of tibia and soft tissue. Methods The retrospective analysis was made on 31 cases of large segment defects of the tibia and soft tissue from May 2009 to May 2016. They were 27 males and 4 females, from 2 to 58 years of age (average, 33.4 years). The soft tissue defects ranged from 7cm×8cm to 24 cm×12 cm. The tibia defects ranged from 6.5 cm to 18.2 cm, averaging 11.4 cm. The follow up ranged from 1 to 8 years, averaging 32 months. The observation were made on the healing of bone, soft tissues and the complications. Results For all the cases, the infection was eliminated, and the bone and soft tissue were healed. 4 cases showed delayed healing of bone fractures and healed after bone grafting. 3 cases had wound infection and poor bone formation in the extended bone area. They were healed after placing vancomycin cement stick for 2 months and treated with "accordion" technique; the other bone defects were healed; Soft tissue wounds healed smoothly. The healing time of soft tissue was 65 d -190 d, with an average of 70 d. The bone healing time was 14-35 months with an average of 21.6 months. The limb length of 28 patients completely recovered, and the limb of 3 patients was 1.5 cm shorter than the healthy side. Conclusion For the composite bone and skin defects of the tibia which was longer than 8 cm, bifocal corticotomy could shorten the treatment period. The main complications were nonunion of the docking site, malformation of the callus and mechanical axis deviation which could be corrected by proper techniques.