Ilizarov外固定架骨搬移技术联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露的疗效分析

[目的]探讨和总结Ilizarov外固定架骨搬移技术联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露的手术方法及其疗效。[方法]本科2011年10月~2013年12月应用Ilizarov环形外固定架联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露患者16例;小腿软组织缺损范围(4.0~6.0)cm×(3.0~4.5)cm,胫骨骨缺损长度4.5~8.0 cm,平均6 cm。先清创取出死骨块、VSD技术覆盖创面控制感染,再用Ilizarov骨搬移技术使骨缺损修复,骨折愈合。参照Paley评价标准进行功能评价,并分析其骨折愈合时间、带外固定架时间、术后患肢功能恢复情况。[结果]所有病例均获得随访,随访时间9~24个月,平均10.5个月。其中11例应用皮瓣转移覆盖创面修复,3例通过游离皮片移植创面愈合,2例经换药愈合,软组织修复良好。使用VSD 3~6期,平均4.8期;带外固定架时间6~18个月,平均10.3个月;骨段搬移延长4.5~8.0 cm,平均6 cm;骨折愈合时间6~15个月,平均9.8个月。根据Paley骨折愈合与功能分级评价骨搬移结果及功能,优9例,良5例,可2例。[结论]Ilizarov外固定架骨搬移技术联合皮瓣、VSD技术治疗胫骨长段骨缺损及骨外露具有操作简便、疗效肯定、并发症发生率低、可随时调整纠正畸形等优点,值得推广。     

骨-软组织复合搬移技术治疗伴有皮肤缺损的胫骨骨缺损

[目的]评价骨-软组织复合搬移技术治疗伴有皮肤缺损的胫骨骨缺损的可行性及临床效果。[方法]2011年10月~2014年7月对7例伴有皮肤缺损的胫骨骨缺损患者行骨-软组织复合搬移治疗。男5例,女2例,年龄25~54岁,平均35.2岁。彻底清创,截除病骨,干骺端截骨,安装Ilizarov外固定架行骨-软组织复合搬移治疗伴有皮肤缺损的胫骨骨缺损。定期随访,软组织靠拢后,予以清创缝合。随访X线片示两缺损端对合后,根据骨愈合及矿化情况,逐步简化Ilizarov外固定架,达到骨性愈合后,拆除外固定架。统计并发症、骨愈合情况,踝、膝关节功能。[结果]所有患者均获随访,时间6~33个月,平均24个月。所有患者均未出现外支架取出后再次骨折,患膝、踝关节功能良好。1例出现钉道感染,经清创换药及抗生素治疗后感染控制;1例出现外固定架术后软组织阻挡,行软组织松解术后阻挡解除。Paley骨愈合评分标准评定优5例,良2例。[结论]骨-软组织复合搬移技术是治疗伴有皮肤缺损的胫骨骨缺损的有效方法,具有创伤小、操作简单、易于推广等优点。     

择期Ilizarov骨搬移技术治疗胫骨感染性骨缺损

目的探讨和总结择期Ilizarov外固定架辅助下骨搬移技术治疗胫骨感染性骨缺损的治疗方法及临床效果。方法我院自2011年11月至2014年1月择期采用Ilizarov环形外固定架辅助下骨搬移技术治疗胫骨感染性骨缺损患者17例,男13例,女4例;年龄20~59岁,平均36岁。受伤原因:9例交通事故,5例高处跌落,3例砸伤,均系开放性骨折,其中GustiloⅡ型1例,GustiloⅢA型5例,GustiloⅢB型7例,GustiloⅢC型4例;左侧5例,右侧12例;骨缺损部位在胫骨上段7例,中段6例,下段4例。骨延长-骨搬移前骨缺损长度6~10cm。感染创面清创后软组织缺损面积约3cm×4cm~7cm×9cm。一期手术清理创面:去除感染骨段、植入骨水泥链珠或以VSD及皮瓣覆盖创面控制感染;择期应用Ilizarov外固定架骨延长-骨搬移技术通过骨段输送或加压使骨缺损修复、重建。分析各项指标如骨缺损长度、携带外固定架时间等,并对患肢功能恢复程度进行评分。结果所有病例随访时间10~22个月,平均13.5个月。其中12例应用皮瓣患者术后均成活,余5例经游离植皮或换药愈合。胫骨骨段搬移或延长6~10cm,平均7cm;外固定架携带时间7~16个月,胫骨缺损均获得重建,平均11个月。根据Paley标准评价骨延长-骨搬移结果及功能,优13例,良3例,可1例,优良率94.1%。结论择期Ilizarov外固定架辅助下骨搬移技术治疗胫骨感染性骨缺损具有治疗周期短、并发症少等特点,同时重建肢体及矫正畸形,疗效满意,值得临床推广及应用。     

抗生素骨水泥链珠结合骨搬移技术分期治疗下肢长骨慢性骨髓炎

目的 探讨应用抗生素骨水泥链珠结合骨搬移技术分期治疗下肢长骨慢性骨髓炎的临床疗效,寻找有效解决长骨慢性骨髓炎的治疗方案。方法 选自我院2012年1月至2016年1月行手术治疗的股骨及胫骨慢性骨髓炎患者32例,采用分期治疗,一期进行彻底清创、去除死骨、放置万古霉素骨水泥链株,安装环形外固定延长架,二期取出万古霉素抗生素链珠,进行截骨延长、骨搬移,定期拍片检查骨搬移情况,骨搬移结束后视断端对合情况决定是否植骨。结果 32例患者治疗结束后炎症完全控制,且均达到骨性愈合,其中12例在搬移结束后行自体骨移植,20例断端对合后骨性愈合,所有患者均恢复了日常生活。结论 抗生素链珠结合骨搬移技术分期治疗下肢长骨慢性骨髓炎临床疗效肯定,慢性骨组织炎症经局部使用抗生素链珠后感染被控制,而后行骨搬移技术进行缓慢骨搬移,最终达到骨性愈合,为临床上治疗较为棘手的慢性骨髓炎提供一种有效的方法。     

Ilizarov技术联合载抗生素人工骨Ⅰ期治疗管状骨骨髓炎

目的探讨Ilizarov技术联合载抗生素人工骨Ⅰ期治疗管状骨骨髓炎的临床疗效。方法自2011年3月至2015年12月治疗本院的慢性管状骨骨髓炎患者12例,男7例,女5例,均Ⅰ期行病灶清除、载抗生素人工骨植入、Ilizarov环形外固定架固定、干骺端微创截骨、创面修复。术后1周左右开始骨搬移。结果 12例患者均获得6~24个月随访,平均17.5个月,均获得稳定骨愈合及良好的皮肤软组织愈合。骨外固定时间6~13个月,平均7.35个月。人工骨在影像学上的吸收时间1~3月,平均2.1月。结论 Ilizarov技术联合载抗生素人工骨Ⅰ期治疗管状骨骨髓炎具有良好疗效,值得临床推广。     

抗生素骨水泥珠链联合负压封闭引流技术治疗慢性骨髓炎伴软组织缺损

目的 探讨抗生素骨水泥珠链联合负压封闭引流(VSD)技术治疗慢性骨髓炎伴软组织缺损的临床疗效. 方法 2007年7月至2010年6月共收治42例四肢慢性骨髓炎患者,男35例,女7例;年龄25 ～ 62岁,平均37.2岁.对所有患者局部行彻底清创、抗生素骨水泥珠链植入并同时行VSD治疗.7～10d后,打开创面,取出抗生素骨水泥珠链,再次清创.若创面清洁、肉芽组织新鲜,则行游离植皮或皮瓣移植覆盖创面;若创面欠清洁,再次抗生素骨水泥珠链植入并同时行VSD治疗,择期行植皮或皮瓣移植覆盖创面.结果 42例患者术后获6 ～ 26个月(平均13个月)随访.37例患者应用1次VSD治疗,5例患者应用2次VSD治疗;29例患者创面植皮,创面愈合良好;13例患者创面行带血管蒂游离皮瓣移植,皮瓣均存活.10例患者皮瓣切口一期愈合良好,3例患者皮瓣皮缘局部变黑、坏死,经2～3周换药后愈合.所有患者骨折均顺利愈合,5例骨缺损患者植骨后改为接骨板螺钉内固定,局部无感染复发.植皮及皮瓣移植前创面均未培养出细菌.术后l、2、3周白细胞、血沉及C反应蛋白均在正常范围内. 结论 彻底清创、抗生素骨水泥珠链植入联合VSD技术是治疗慢性骨髓炎伴软组织缺损简单而有效的方法.     

抗生素骨水泥联合Ilizarov技术在长骨感染性骨缺损治疗中的应用

目的探讨抗生素骨水泥联合Ilizarov技术个性化治疗长骨感染性骨缺损的方法和临床疗效。方法自2011年6月至2017年1月,我院应用Ilizarov技术个性化治疗股骨、胫骨、肱骨骨折术后感染性骨缺损21例,男14例,女7例;年龄18～65岁,平均37岁。其中胫骨骨缺损12例,清创后骨缺损范围平均7.2cm;股骨骨缺损7例,清创后骨缺损范围平均8.5cm;肱骨骨缺损2例,清创后骨缺损范围平均6cm。手术分两期进行:一期彻底清创,植入含敏感抗生素骨水泥,采用单边或环形外固定架固定,预留截骨延长的外固定架长度,控制感染;二期感染消灭后,根据Ilizarov技术进行截骨延长。结果所有患者术后随访12～24个月,平均18.5个月。外固定架固定时间9～21个月,平均17.2个月。外固定架指数(external fixation index,EFI)平均为2.38个月/cm。采用伊里扎洛夫方法研究与应用学会(association for the study and application of the method of Ilizarov,ASAMI)评价标准评价,骨性结果:优13例,良6例,中2例,优良率为90.5%;功能结果:优11例,良7例,中3例,优良率为85.7%。结论抗生素骨水泥联合Ilizarov技术可有效控制感染,纠正患肢畸形,重建肢体的功能,是治疗长骨感染性骨缺损的有效方法。     

骨搬移结合载抗生素硫酸钙治疗慢性骨髓炎

目的探讨病变骨段切除后骨搬移结合载抗生素硫酸钙治疗慢性骨髓炎的效果。方法回顾性分析2018年1月至2019年8月,采用骨搬移结合载抗生素硫酸钙治疗17例慢性骨髓炎患者资料,男12例,女5例;年龄16～63岁,平均(35.2±3.1)岁;股骨骨髓炎3例,胫骨骨髓炎14例。术中均行骨髓炎病变骨段切除,环形外固定架或单边外固定支架固定,载抗生素硫酸钙植入骨缺损处,骨搬移修复骨缺损。结果患者均获随访,随访时间10～15个月,平均(12.7±1.6)个月。17例患者中,股骨病变骨段切除3例,胫骨病变骨段切除14例;7例安装环形外固定架,10例安装单边外固定架。其中股骨安装单边外固定架;胫骨可选择环形外固定架或单边外固定架,但如病变骨段切除后骨缺损较大,考虑单边外固定架稳定性不够或无法安装时则选择环形外固定架。患者术中均植入载抗生素硫酸钙。一期截骨骨搬移8例,二期截骨骨搬移9例。骨段搬移时间2～5个月,平均(3.5±1.4)个月。搬移骨段会合后矿化时间6～14个月,平均(8.3±1.8)个月。外固定架固定时间9～15个月,平均(12.3±2.7)个月。外固定指数1.2～2.6个月/cm,平均(1.5±0.3)个月/cm。硫酸钙吸收时间1～2个月,平均(1.6±0.2)个月。术后出现钉道感染3例,马蹄足畸形1例。所有患者均未出现血管神经损伤,治疗有效率为100%。患肢功能恢复情况按Paley标准评价,优良率为94.12%。膝关节活动度手术前后无差异,术后生活质量评分较术前高。结论骨搬移结合硫酸钙抗生素载体治疗慢性骨髓炎,既能对骨髓炎病灶进行根治性手术,又能提升临床疗效与患者生活质量。     

骨搬移联合皮瓣移植术在小腿医源性感染治疗中的应用

目的总结骨搬移联合皮瓣移植术修复胫骨骨折内固定术后医源性感染导致皮肤软组织及骨缺损的经验。方法自2009-06—2013-02诊治13例胫骨骨折内固定术后医源性感染而发生骨髓炎患者,皮肤软组织缺损采用游离皮瓣进行修复;骨缺损修复二期进行,均采用Ilizarov环形外固定架作为牵张和外固定支具。结果 13例均获得随访6~48个月,平均14个月。10例创面一期愈合,3例皮瓣部分坏死,再次行交腿皮瓣和局部皮瓣转移修复,1例成功,2例因感染迁延不愈而截肢。11例骨再生良好,6例骨端一期愈合,5例完成牵张过程后二次手术植骨愈合。结论 Ilizalov技术能很好地促进骨缺损后骨的再生,结合皮瓣移植术治疗医源性感染后发生的骨髓炎效果良好。     

自制抗生素骨水泥珠链治疗医源性慢性骨髓炎

目的：探讨抗生素骨水泥珠链植入结合外固定架固定治疗医源性慢性骨髓炎的疗效。方法：本组50例患者,先取出内固定物,清创后植入抗生素骨水泥珠链,Ⅰ期闭合伤口;行外固定架固定：Ⅱ期取出抗生素骨水泥珠链,取髂骨植骨。结果：随访11-40个月（21．51±4．52月）。46例伤口Ⅰ期愈合,植骨患者32例植骨全部愈合。结论：彻底清创、抗生素骨水泥珠链植入结合外固定架固定及Ⅱ期植骨是治疗感染性骨折不愈合简单而有效的方法。     

Ilizarov外固定器结合病灶清除及植骨术在治疗感染性骨不连及慢性骨髓炎的应用

【摘要】〓目的〓探讨应用Ilizarov外固定器治疗骨感染和骨不连的技术和经验。方法〓2012年~2013年,对18例骨感染和骨不连病人接受治疗,其中感染性骨不连12例,骨髓炎6例。根据感染的部位和范围预先在患肢安装Ilizarov外固定器,将感染波及的骨干彻底整段切除后,再在缺损段的远或(和)近侧干骺端行一期截骨延长。结果〓16例患者一期伤口痊愈且无破溃,骨愈合良好,随访10个月无骨髓炎复发的表现。2例患者术后1个月再次伤口破溃流脓,提示感染复发,按上述方法重新治疗后愈合。随访12~18个月,所有患者均达到骨性愈合,肢体外观和功能效果令人满意。结论〓应用Ilizarov技术,采用大段病骨切除同时截骨延长的方法是治疗外伤后感染性骨不连与骨髓炎的有效方法,并同时恢复肢体长度和矫正马蹄足畸形。     

Management of childhood chronic tibial osteomyelitis with the Ilizarov method

The efficacy of the Ilizarov method in the management of the long bone defect is well established. There have been rare reports about the use of the Ilizarov method in the bone defect caused from childhood osteomyelitis. In this article, the authors present results of seven patients with childhood chronic hematogenous osteomyelitis of the tibia who were treated with the Ilizarov method. The treatment protocol also included sequestrectomy and debridement, appropriate antibiotic therapy, and bifocal treatment with the Ilizarov method. The mean age was 7.2 years old (range 6-8). After sequestrectomy and debridement, all cases were classified as B1 infected pseudoarthrosis according to Paley's criteria. All patients had active infection at the beginning of the treatment. The mean bone defect was 7.4 cm (range 3.5-12). Follow-up time was 4.6 years (range 2.7-5.8). At the time of fixator extraction, complete consolidation was obtained in all the patients. Healing index was 32.3 days/cm (range 28-44). Bone grafting was not required at the docking site in any of the patients. Functional and radiologic results were judged excellent according to Paley's criteria in all patients at the last follow-up. This study indicates that the bifocal method of the Ilizarov treatment is the best alternative for the bone defect caused by chronic hematogenous osteomyelitis in children.     

腓肠神经营养血管腓肠肌外侧头复合瓣转移治疗胫骨骨髓炎

目的 探讨腓肠神经营养血管皮瓣与腓肠肌外侧头一同切取成复合瓣的可行性,观察应用复合瓣转移治疗胫骨骨髓炎的疗效. 方法 在尸体标本上观察腓肠神经营养血管蒂与深层的腓肠肌外侧头之间的血管比邻关系.对15例胫骨骨髓炎的患者采用窦道切除、胫骨开槽的方法进行彻底清创,采用远端蒂腓肠神经营养血管与腓肠肌外侧头的复合瓣转移覆盖窦道切除后的皮肤缺损区,将肌肉部分尽量填塞入胫骨骨槽内,置负压引流;3例骨不连患者拆除内固定后更换外固定支架. 结果 腓肠神经营养血管筋膜蒂与腓肠肌外侧头之间有5～6支血管穿支,可以一同切取为复合皮瓣;临床治疗15例患者转移复合瓣全部成活,14例胫骨骨髓炎完全治愈,1例患者经过第二次清创后完全愈合,3例骨不连者经二期髂骨植骨后6个月完全愈合,平均随访18个月(10～26个月)无复发. 结论 腓肠神经营养血管蒂与深层的腓肠肌外侧头有血管穿支存在,二者可以切取成远端蒂的复合瓣,可有效治疗胫骨骨髓炎.     

Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail

BACKGROUND: Callus distraction over an intramedullary nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical débridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an intramedullary nail for the treatment of bone defects and limb-shortening resulting from radical débridement of chronic osteomyelitis. METHODS: Thirteen patients who ranged in age from eighteen to sixty-three years underwent radical débridement to treat a nonunion associated with chronic osteomyelitis of the tibia (seven patients) and femur (six patients). The lesions were classified, according to the Cierny-Mader classification system, as type IVA (nine) and type IVB (four). The resulting segmental defects and any limb-length discrepancy were then reconstructed with use of distraction osteogenesis over an intramedullary nail. Two patients required a local gastrocnemius flap. Free nonvascularized fibular grafts were added to the distraction site for augmentation of a femoral defect at the time of external fixator removal and locking of the nail in two patients. At the time of the latest follow-up, functional and radiographic results were evaluated with use of the criteria of Paley et al. RESULTS: The mean size of the defect was 10 cm (range, 6 to 13 cm) in the femur and 7 cm (range, 5 to 10 cm) in the tibia. The mean external fixator index was 13.5 days per centimeter, the consolidation index was 31.7 days/cm, and the mean time to union at the docking site was nine months (range, five to sixteen months). At a mean follow-up of 47.3 months, eleven of the thirteen patients had an excellent result in terms of both bone and functional assessment. There were two recurrences of infection necessitating nail removal. These patients underwent revision with an Ilizarov fixator. Subsequently, the infection was controlled and the nonunions healed. CONCLUSIONS: This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation.     

Reverse Sural Flap with Bifocal Ilizarov Technique for Tibial Osteomyelitis with Bone and Soft Tissue Defects

Tibial osteomyelitis, in association with bone loss and a soft tissue defect, poses a significant reconstructive challenge, especially in high-risk patients. We describe a case of methicillin-resistant Staphylococcus aureus tibial osteomyelitis with intercalary bone loss successfully managed with bifocal Ilizarov compression osteogenesis at the bone resection site and proximal distraction osteogenesis, accompanied by a reverse sural fasciocutaneous flap performed with a delayed technique. When free tissue transfer is not a reconstructive option owing to medical comorbidities or patient refusal, the reverse sural flap combined with bifocal Ilizarov compression and distraction osteogenesis can provide a reconstructive option to achieve limb salvage for these challenging cases.     

清创一期植骨及腓肠神经皮瓣治疗跟骨慢性骨髓炎伴软组织缺损

【摘要】 目的 探讨清创、一期植骨联合腓肠神经皮瓣移植治疗跟骨慢性骨髓炎伴软组织缺损的疗效。方法 2008年11月~2011年11月,对 12例合并软组织缺损的跟骨慢性骨髓炎患者采用清创、一期植骨联合腓肠神经皮瓣移植修复创面,观察术后皮瓣成活、骨髓炎治愈及踝关节功能情况。结果 术后随访9~24个月,平均 17个月。9例皮瓣Ⅰ期愈合,3例窦道形成或边缘坏死经处理后愈合;随访期间无骨髓炎复发;根据美国足踝外科协会(AOFAS ) 踝后足功能评分术后(89.4±7.8)较术前(42.8±15.3)明显提高,差异有统计学意义(P<0.05)。结论 跟骨慢性髓炎合并软组织缺损通过彻底清创、一期植骨及腓肠神皮瓣移植取得良好的效果,该方法具有疗效确切、疗程短、简单易行等特点。     

Treatment of chronic osteomyelitis complicating nonunion and segmental defects of the tibia with open cancellous bone graft, posterolateral bone graft, and soft-tissue transfer

Forty-two consecutive patients with chronic osteomyelitis complicating persistent tibial nonunion and chronic osteomyelitis complicating tibial fracture with segmental bone loss were treated from January 1979 through December 1986 using a protocol including either open cancellous bone grafting (Friedlaender-Papineau technique), posterolateral bone grafting (Harmon technique), or local or microvascular soft-tissue transfer before cancellous bone grafting. Each patient had undergone surgical debridement and intravenous antibiotic therapy before inclusion in this study. Patients were classified using a staging system which included consideration of anatomic location of the infection within the bone; extent of bone involvement; quality of soft-tissue envelope and vascular integrity; and generalized host status. The overall success rate for arresting the osteomyelitis and healing the nonunion was 62% (26/42). If the six patients who refused additional bone graft surgery, the one patient who represented poor patient selection, and the patient who refused ankle arthrodesis are eliminated, the success rate for healing of the nonunion and resolving the osteomyelitis in this difficult patient population is: open bone cell graft, 66% (12/18); soft-tissue transfer 87.5%, (7/8); and posterolateral bone grafting, 87.5% (7/8). Use of a standardized classification system allows comparison of treatment results. Adequate debridement is crucial in treating osteomyelitis complicating established long bone fractures and nonunions. Determining the extent of debridement has proven to be the single most difficult aspect technically. Patient selection and pretreatment education are crucial. Caring for these patients is not only labor intensive and demanding of personnel and hospital resources, but demanding of the patients as well.     

Successful treatment of chronic osteomyelitis in children with debridement,antibiotic-laden cement spacer and bone graft substitute

Purpose

Chronic osteomyelitis and infected nonunion are relatively rare conditions in pediatric patients and are more frequently seen in developing countries. Although relatively rare, they are medically and surgically challenging. Here we report a novel surgical technique used to manage five patients with chronic osteomyelitis of long bones.

Methods

Five skeletally immature patients with chronic osteomyelitis and infected nonunion of the long bones were treated surgically between 2010 and 2014 by a combination of resection of necrotic infected bone, debridement of surrounding soft tissue, and application of antibiotic-laden cement spacer inducing periosteal membrane before final bone reconstruction. Once inflammatory markers normalized, all the patients were re-operated for cement removal, bone graft substitution, and concomitant osteosynthesis of the affected bone, if needed. All patients underwent MRI, CT scan, and laboratory evaluation prior to surgery. The antibiotic regimen was started empirically and then adjusted according to culture and sensitivity results.

Results

Mean patient age at the time of diagnosis was 11 years (range 4–14), and all patients had at least 2-year follow-up (range 2–5). At last follow-up, clinical and laboratory evaluation had normalized, the bone had healed, and all patients had resumed daily living and sports activities.

Conclusion

Surgical debridement is the standard approach to chronic osteomyelitis. Use of antibiotic-laden cement is recommended to penetrate local infection, with antibiotic therapy playing an adjunctive role. The cement also induces membrane formation that aids bone reconstruction.

Level of evidence

IV.

     

Correction of complex lower limb deformities by the Ilizarov technique: An audit of complications

This is an audit of complications resulting from correction of complex lower limb deformities by the Ilizarov technique. 33 patients (40 bone segments) were reviewed and divided into 4 groups according to the type of surgery carried out: limb lengthening and/or correction of deformity, bone or joint stabilisation, treatment of nonunion or bone defect, angular and/ or rotation correction. Most minor complications were fixator specific. Pin tract infections were almost universal but responded well to oral antibiotics and rarely resulted in osteomyelitis. Major complications were procedure specific and more common in those patients who underwent leg lengthening, treatment for nonunion and bone transport. There was also a high incidence of nerve injury as a result of acute angular deformity correction. Despite the high complication rate the Ilizarov technique remains an effective tool for complex lower limb reconstruction surgery.     

负载妥布霉素的硫酸钙治疗慢性骨髓炎及合并骨缺损的疗效评价

目的评价应用负载妥布霉素的硫酸钙（Osteoset-T）治疗慢性骨髓炎及合并骨缺损的疗效.方法自2004年4月起,采用Wright公司的Osteoset-T治疗慢性骨髓炎患者4例,慢性骨髓炎合并骨缺损患者11例.其中同时应用带蒂腓肠神经营养皮瓣转移治疗慢性窦道切除后皮肤缺损4例,带蒂小腿内侧皮瓣转移修复1例,平行桥式血管吻合游离背阔肌皮瓣移植1例.所有骨髓炎病例经过彻底清创,去除死骨与肉芽组织后植入Osteoset-T 5～25 mL,平均8.3 mL.结果所有患者平均随访4.5个月.15例患者中13例感染得到控制;2例混合感染者术后渗出较多,经过再次清创取出分解的Osteoset-T后创面愈合.11例骨髓炎合并骨缺损患者中5例术后4周开始出现不同程度的新骨形成,其中3例跟骨骨髓炎患者术后2个月部分负重行走,3个月恢复行走;1例股骨骨髓炎合并骨不连患者术后2个月新骨形成;1例桡骨骨髓炎患者术后6个月骨完全愈合.6例炎症得到控制但无新骨形成,均行自体骨或异体骨植骨后2例已经完全愈合,4例在愈合过程中.结论应用彻底清创合并Osteoset-T可以有效地治疗慢性骨髓炎,并可在一定程度上促进新骨的形成.