骨段滑移术治疗胫骨缺损合并软组织缺损

目的 探讨骨段滑移术治疗胫骨骨缺损合并小腿软组织缺损的疗效.方法 自2001年7月至2006年7月,共收治胫骨骨缺损合并小腿软组织缺损的患者57例.男42例,女15例;年龄15～52岁,平均34岁.57例胫骨缺损长度为5～20 cm(平均11 cm),小腿前内侧皮肤缺损5 cm×4 cm～20 cm×8cm.对12例行一期胫骨截骨术,其余45例行二期截骨术.截骨术后10～14 d开始延长,每日延长1 mm.在胫骨远,近缺损骨端相遇后,对对合良好者加压以促进愈合,对缺损骨端之间对合不好、皮肤内陷、骨不愈合和(或)感染者行复位、清创或自体骨植骨术.结果 从开始治疗到去除外固定架,平均治疗用时21(11～32)个月.56例胫骨缺损得以重建,患肢肢体长度与健侧相差<4mm.1例新生骨部分成骨不良,行自体骨植骨术.创面均得到覆盖,仅2例要求接受瘢痕皮肤修整术.15例(26%)患者骨缺损接触端自行愈合,1例长期存在一个窦道,清创术后随访半年感染无复发,窦道愈合.骨段滑移过程中4例患者主诉膝部疼痛,11例主诉小腿疼痛.6例患者出现马蹄内翻足.5例出现轻度屈膝畸形,经功能锻炼4例恢复,1例屈膝10°.结论 骨段滑移术是治疗胫骨骨缺损合并软组织缺损的有效方法,其疗效满意.

Management of bone defect of tibia and soft tissue loss with bone transport

Objective To probe into the role of bone transport on managing tibial bone defect accompanied by anterior-medial soft tissue loss. Methods Orthofix external fixator of lower limb reconstruction system were applied to the medial or anterior-medial side of 57 injured legs. The average tibial defect is 11 (5-20) cm, the largest skin loss area on the anterior-medial side of the leg is 20 cm×8 cm, the smallest area is 5 cm×4 cm. Twelve cases underwent subperiosteal osteotomy in the primary stage; remaining 45 cases underwent secondary osteotomy 2-6 weeks after debridement. The bone segments were transported 10-14 days following osteotomy and proceeded at a rate of 0.25 mm every 6 hour. In case of soft tissue obstruction, docking site mismatch or limited contact, infection and non-union at the docking site, bone grafting, manipulation and realignment and resection were required. Results The average time of treatment which is from debfidement to removal of external fixator is 21 (11-32) months. A good tibial hone reconstruction was atmined in 56 cases, poor bone formation was observed in one case that healed with bone grafting. Limb length discrepancy is less than 4 ram. All wounds were repaired without flaps. Two patients needed plastic surgery. 26% of cases had their docking site healed spontaneously, 1 patient who had a fistula at the docking site had no infection for over 6 months after debridement. Four patients complained pain around knee joint, 11 complained pain at the legs. Six patients had equinus-varus. Five patients had mild knee flexion deformity, and 4 of them recovered. Conclusion Bone transport is effective and satisfactory for managing tibial bone defect accompanied by anterior-medial soft tissue loss.