单臂骨外固定架并植骨治疗胫骨骨折骨不连23例

目的探讨单臂骨外固定架并植骨治疗胫骨骨折骨不连疗效。方法自2001年3月至2005年3月应用单臂骨外固定架并植骨治疗胫骨骨折骨不连23例并观察疗效。结果术后骨折经2.5~5个月骨折愈合,平均3.6个月。结论骨外固定架并植骨治疗胫骨骨折骨不连是一种简便又实用的治疗方法。     

骨感染

长骨骨折内固定术后迟发性感染的综合治疗；髓内延长修复儿童股骨骨髓炎后骨缺损；带血管骨皮瓣移植治疗胫骨感染性骨不连；前路内固定在治疗胸腰椎结核中的作用；游离髂骨皮瓣移植一期修复胫骨创伤后骨髓炎骨缺损；胸腰椎结核稳定性前路重建26例分析；应用纳米羟基磷灰石；单臂外固定架下骨内移位技术治疗胫骨感染性骨不连；17例颈椎结核外科手术治疗分析     

肢体短缩延长术治疗胫骨感染性骨缺损及慢性骨髓炎疗效观察

目的探讨采用肢体短缩延长术治疗胫骨感染性骨缺损及慢性骨髓炎的疗效。方法 2011年1月—2016年4月采用肢体短缩延长术治疗胫骨感染性骨缺损及慢性骨髓炎19例。男13例,女6例;年龄22~62岁,平均44岁。致伤原因:交通事故伤16例,压砸伤1例,高处坠落伤2例。18例为小腿开放性骨折(GustiloⅢB型)外固定支架固定后形成感染性骨缺损、骨髓炎,1例为闭合骨折内固定术后感染形成慢性骨髓炎。既往手术2~5次,平均3次。受伤至骨搬移术时间为3~11个月,平均6.5个月。清创后骨缺损长度为2.0~5.5 cm,平均4.3 cm。术中胫骨短缩后松开止血带检查肢体末梢血运,7例直接闭合创面,5例采用邻近皮瓣修复,5例采用腓肠神经营养血管皮瓣修复,1例采用腓肠肌内侧头肌皮瓣修复,1例单纯植皮修复。选用单臂外固定架或环式外固定架,并在胫骨近侧或远侧干骺端的两排外固定架钉之间完全锯断;1周后以1 mm/d速度进行肢体延长。结果术后19例患者均获随访,随访时间10~36个月,平均14个月。2例对合端创面延迟愈合,余均顺利愈合。18例对合骨端自然愈合,1例因病灶骨未完全切除致对合骨端发生骨不连。5例发生牵张骨痂生长缓慢,其中4例经"手风琴"技术和注射红骨髓后顺利愈合,1例植骨辅助内固定后对合骨端愈合。骨延长时间为1~3个月,延长指数为1.6~2.7 cm/月,平均2.2 cm/月;骨愈合时间为7~13个月,平均11.1个月。根据胫骨骨折疗效评定系统Johner-Wruhs评分评定疗效:优9例,良8例,中2例,优良率为89.5%。结论采用肢体短缩延长术治疗胫骨感染性骨缺损及慢性骨髓炎,可改善截骨端的直接对合,明显缩短骨对合端的愈合时间。     

带血管骨皮瓣移植治疗胫骨感染性骨不连

[目的]回顾总结带血管骨皮瓣移植治疗胫骨感染性骨不连的方法和疗效。[方法]从2002年8月~2004年8月,应用单边外固定架稳定骨折端,同时行带血管骨皮瓣移植治疗18例胫骨感染性骨不连,男15例,女3例,年龄18~51岁,平均34岁。清创后胫骨缺损3~8 cm,软组织缺损4 cm×3 cm~18 cm×9 cm。14例行带血管髂骨皮瓣移植修复,4例行带血管肩胛骨皮瓣移植修复,术后随访8~30个月,平均17个月。[结果]18例骨皮瓣全部成活,胫骨及软组织缺损Ⅰ期修复,外固定架固定牢固,获得骨性愈合时间8~13个月,平均10个月,3例出现外固定架钉道感染,1例发生取髂骨处疼痛。[结论]带血管骨皮瓣移植联合外固定架固定是治疗胫骨感染性骨不连行之有效的方法,Ⅰ期解决骨及软组织缺损的问题,促进骨的愈合。     

单臂外固定架治疗胫骨远端骨折22例

目的探讨单臂外固定架治疗胫骨远端骨折的疗效。方法根据骨折分型确定外固定针的安放部位，A型骨折在骨折两端置外固定针；远端骨折块过小不能容纳外固定针者以及B和C型骨折在骨折近端和跟骨及距骨安放外固定针。撑开复位，复位困难者部分切开复位，植骨螺钉或克氏针固定，合并腓骨骨折同时行切开复位内固定。结果22例外固定架固定3．5-8个月，平均5个月，骨折均愈合，无严重深部感染、骨髓炎、骨折不愈合等严重并发症。随访10-32个月，平均20个月，拆除外固定架康复6个月以上，按Tornetta胫骨远端骨折治疗标准，优11例，良7例，可3例，差1例。结论单臂外固定架固定联合有限切开内固定是治疗胫骨远端骨折简单有效的微创治疗方法之一。     

骨搬移治疗胫骨感染性骨不连

目的分析骨搬移治疗胫骨感染性骨不连的临床疗效。方法2002年10月至2007年10月采用胫骨感染骨端清创、重建外固定支架加压固定及胫骨干骺端截骨骨搬移治疗胫骨感染性骨不连、纠正肢体短缩畸形45例。结果45例胫骨感染均得到一期控制,软组织缺损创面消灭,4例出现钉道感染;44例骨折愈合,1例骨折端再次形成骨不连;39例双下肢长度基本恢复一致,6例仍有1．5～3cm肢体短缩畸形存在,1例因截骨端提前愈合使肢体未能达到预期长度;术后截骨端骨延长2～9cm,平均延长6cm,无血管及神经损伤的症状出现;术后外固定支架固定6～12个月,平均8个月,所有病例延长区新骨组织形成良好。结论采用骨搬移治疗胫骨感染性骨不连,能达到一次手术兼顾控制骨端感染、消灭皮肤创面、骨折端不需植骨达到骨性愈合及均衡肢体长度的临床治疗作用,是治疗胫骨感染性骨不连的理想方法。     

单臂外固定架治疗胫骨骨不连临床疗效分析

目的:探讨单臂外固定架治疗带锁髓内钉术后胫骨骨不连的临床疗效。方法:带锁髓内钉术后胫骨骨不连患者47例,男40例,女7例;年龄22～61岁,平均37.5岁;带锁髓内钉固定时间11～26个月;胫骨中上段骨折11例,中下段36例。先按原切口取出带锁髓内钉,选择合适的切口修整骨折端硬化骨,行腓骨斜行截骨植骨,全部采用单臂外固定支架固定并髂骨植骨治疗。结果:47例均获随访,时间12～36个月。44例骨折愈合;2例再次出现骨不连,经单纯植骨加压外固定治疗愈合;1例感染并骨不连,控制感染后采用管形石膏加植骨治疗后愈合。术后并发骨筋膜室综合征3例,踝关节僵直11例,患肢不等长6例。结论:单臂外固定架治疗胫骨骨不连,方法简单,固定可靠,减少患者痛苦。     

骨搬移治疗胫骨感染、骨缺损及软组织缺损

目的分析骨搬移治疗胫骨感染、缺损及软组织缺损的临床疗效。方法采用胫骨感染骨端清创、重建延长器外固定架及胫骨干骺端截骨骨搬移治疗胫骨感染、缺损及软组织缺损7例。结果 1例出现钉道感染,7例骨折均愈合,术后截骨端骨延长3.5~8.5 cm,平均4.5 cm,无血管和神经损伤的症状。结论采用Ilizarov骨搬移技术治疗胫骨感染、骨缺损及软组织缺损,可以一次性解决骨端感染、消灭皮肤缺损,且骨折断端不需要植骨即可达到骨性愈合。     

双轴重合法胫骨干骺端截骨骨延长术

目的：探讨双轴重合法在骨延长术中的应用。方法：回顾性分析54例应用双轴重合法胫骨干骺端截骨骨延长术进行治疗的肢体，其中小儿麻痹症后遗症26例，创伤后双下肢不等长13例，软骨发育不全4例，遗传性矮身材6例，骨斑点病合并双下肢不等长1例，垂体性侏儒症4例。男28例，女26例；平均年龄22岁。所有患者均采用半环形双槽外固定架固定肢体并延长。结果：术后随访18-45个月，平均24．5个月。所有患者均得到肢体延长，延长幅度5—12cm，平均6．2cm。单纯足下垂1例，足下垂合并足外翻2例，较严重针孔感染l例，骨延迟愈合1例。结论：应用双轴重合法胫骨干骺端截骨骨延长术后遗症明显减少，其中骨性并发症减少尤其明显．并降低了手术操作要求，是比较理想的骨延长方法。     

自体骨联合异体骨开放植骨治疗胫骨远端感染性骨缺损的疗效观察

目的评价采用自体松质骨联合同种异体骨开放植骨治疗胫骨远端大段感染性骨缺损的可行性及临床效果。方法自2010-01—2013-01,采用自体骨联合异体骨（2∶1）开放植骨治疗10例胫骨远端感染性骨缺损,骨缺损长度平均5.6（3-8）cm。先用外固定架固定骨折,调整恢复肢体长度及力线,彻底清创,取自体髂骨松质骨剪成直径约5 mm的微粒与同种异体骨2：1混合植入骨缺损处,使骨质稍高于皮肤并超过骨折远近端各1cm。结果 10例获得平均12（9-18）个月随访。术后平均7（5-9）周移植骨质表面被肉芽组织覆盖,7例（1例双侧）创面于术后8-11周自行瘢痕愈合,3例于术后9周行植皮术闭合创面。9例（1例双侧）骨折完全愈合,骨折愈合时间平均8（6-12）个月;1例因胫骨交锁髓内钉取出术后3个月再次骨折伴骨缺损（约8cm）,且术后骨折端不稳、骨缺损较大导致假关节形成,骨折不愈合。结论自体松质骨联合同种异体骨开放植骨是治疗胫骨远端大段感染性骨缺损的一种简单、有效方法。     

单臂外固定架下骨内移位技术治疗胫骨感染性骨不连

目的评价单臂外固定延长支架下采用骨内移位技术治疗胫骨感染性骨不连的临床结果及功能情况。方法回顾性分析了2003年6月至2005年10月28例胫骨感染性骨不连患者的临床资料。其中23例开放性胫骨骨折,ⅢA型5例,ⅢB型11例,ⅢC型7例;内固定后感染5例。根据改良的ASAMI评定标准进行骨具体内容和功能结果评定。结果所有患者均获得随访,平均随访时间16个月。所有骨折获得初期愈合,感染均得到控制,骨折愈合时12例仍有局部窦道和渗液,治疗后软组织愈合。骨评定结果优14例,良9例,中等2例,差3例;功能评定结果优10例,良13例,中等2例,差3例。牵引成骨的平均形成长度为6．6cm,平均愈合所需时间为9个月。最常见的并发症为针道感染,2例在外固定支架拆除后对接点再骨折。结论对于胫骨感染性骨不连,使用单臂延长外固定支架通过骨内移位技术治疗是一种良好的方案。     

U形外固定架结合有限内固定治疗干骺端粉碎性骨折

目的 介绍用U形外固定架治疗长骨干骺端经关节面的粉碎性骨折的疗效。方法 2000年2月～2002年9月对8例患者分别采用切开复位少量螺丝钉内固定及U形骨外固定架固定。结果 全部病例均得到随访,随访时间平均11个月。外固定架术后使用时间平均为3.5个月,骨折愈合时间平均为4.5个月,所有骨折均愈合。无骨不连等发生。终末随访时膝关节活动度平均屈95°,伸180°。踝关节平均背伸10°,跖屈28°。结论 外固定架结合有限内固定治疗经关节面的干骺端粉碎性骨折,可避免伤口并发症和骨不连的发生,即能维持骨折对位恢复关节面的解剖关系,又不妨碍关节活动,是治疗长骨干骺端经关节面粉碎性骨折的较好方法。     

Ilizarov bone transport for massive tibial bone defects

This article reports the treatment of massive tibial bone defects by bone transport using the Ilizarov external fixator. Fifteen patients were treated using this technique (3 females and 12 males). The defect size ranged between 7 and 22 cm (average: 10.6 cm). Etiology was infected nonunion in 9 patients, nonunion in 5 patients, and recurrent giant-cell tumor in 1 patient. The affected site was the tibial diaphysis in 10 patients, the lower tibial metaphysis in 4, and the upper tibial epiphysis in 1 patient. The external fixation time ranged from 9 months to 17 months (average: 12.27 months). External fixation index ranged from 21.8 to 42.5 day/cm (average: 35.7 day/cm). There was no recurrence of infection, no recurrence of the tumor, nor fractures after frame removal. We had to graft the docking site in 2 patients for delayed union and 2 patients developed equinus deformity and had tenoplasty for the Achilles tendon at the time of frame removal. Four patients had pin tract infection at > or =1 of the wires and this was successfully treated by antibiotic injection at the wire site. This study suggests that Ilizarov bone transport is a reliable method to fill massive bone defects.     

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.     

An alternative method for the treatment of nonunion of the tibia with bone loss

In this retrospective study we evaluated the method of acute shortening and distraction osteogenesis for the treatment of tibial nonunion with bone loss in 17 patients with a mean age of 36 years (10 to 58). The mean bone loss was 5.6 cm (3 to 10). In infected cases, we performed the treatment in two stages. The mean follow-up time was 43.5 months (24 to 96). The mean time in external fixation was 8.0 months (4 to 13) and the mean external fixator index was 1.4 months/cm (1.1 to 1.8). There was no recurrence of infection. The bone evaluation results were excellent in 16 patients and good in one, while functional results were excellent in 15 and good in two. The complication rate was 1.2 per patient. We conclude that acute shortening and distraction osteogenesis is a safe, reliable and successful method for the treatment of tibial nonunion with bone loss, with a shorter period of treatment and lower rate of complication.     

Central bone transport system optimizes reconstruction of bone defects. Results of 40 treatments

BACKGROUND: This article describes the results, experiences, and advantages of a bone transport system with one single rope or a fully implantable distraction nail for the treatment of bone defects that totally avoids soft tissue cross traction. METHODS: 40 patients with bone defects were treated by central bone transport systems. 30 post-traumatic defects (12 aseptic, 18 post-septic) and 10 defects after resection of bone tumors (2 benign, 8 malignant). Thirty defects were located at the tibia and ten at the femur; the mean defect size was 10.1 cm; 36 central rope systems and 4 motorized distraction nails were used. The follow-up examination took place after an average of 2.4 years. RESULTS: All defects were totally bridged. The mean distraction time was 131 (57-208) days and the mean time of external fixation 283 (126-326) days. The time of partial load bearing was 466 (302-594) days and the healing index was 47 (33.1-60.4) d/cm. In 34 patients autologous bone grafting at the docking site was performed, and in 30 patients the external fixator was replaced by internal stabilization. The mean leg length discrepancy compared to the contralateral side was 4+/-3 mm, and the leg axis deviation from the center of the knee joint was 1.5+/-7.0 degrees . There were 1.8 complications per patient on average (15 pin tract infections with replacement, 2 premature consolidations). CONCLUSIONS: In contrast to conventional methods reduced pin tract infections offer better conditions for internal fixation. Control of length and axis can be optimized, immobilization of the patients is reduced, and the comfort of treatment is significantly improved.     

Ilizarov技术自体骨段延长治疗胫骨感染性骨折不愈合伴骨缺损

目的 探讨Ilizarov技术自体骨段延长治疗胫骨感染性骨折不愈合的疗效.方法 2000年9月至2006年6月共收治胫骨感染性骨折不愈合伴骨缺损患者14例,男11例,女3例;年龄19～49岁,平均31.9岁;胫骨近端3例,中段8例,远端3例.原始损伤:5例为开放骨折钢板内固定,3例为开放骨折髓内钉内固定,4例为开放骨折外固定架固定,2例为闭合骨折钢板内固定术后所致.患者自受伤至此次治疗时间为2～24个月,平均7.54个月;手术次数平均6次(3～14次).根据Jain骨缺损和感染程度分型:A2型5例,B1型2例,B2型7例.窦道形成10例,骨外露4例;骨外露面积最大7 cm×5 cm,最小2 cm×1 cm;清创后骨缺损长度3～12 cm,平均6.71 cm.14例患者均采用清创联合Ilizarov技术自体骨段延长治疗.结果 14例患者均获8个月～6年(平均20个月)随访,均获稳定骨折愈合.住院时间1～7个月,平均3个月;骨折愈合时间6～12个月,平均7.79个月;骨外固定时间8～14个月,平均9.64个月.并发症:针道感染1例,皮肤过敏1例,骨折畸形愈合再截骨1例,提前矿化再截骨1例,断针1例,无深部感染、骨折不愈合和膝关节僵直发生.根据Paley骨折愈合评分标准:优13例,良1例.结论 Ilizarov骨段延长是治疗胫骨感染性骨折不愈合伴大段骨缺损的一种有效方法.     

锁定钢板内固定治疗四肢骨不连的临床研究

目的 评价锁定钢板内固定治疗四肢长骨骨不连的临床疗效.方法 对2003年2月至2006年10月应用锁定钢板内固定治疗61例骨不连患者的临床资料进行回顾性研究.其中男性44例,女性17例;年龄7～70岁,平均38岁.其中5例肱骨骨不连,33例股骨骨不连,23例胫骨骨不连.骨不连的原因包括内固定失效47例,外固定失败5例,感染9例.骨不连病程为10～156个月,平均19个月.42例使用LCP钢板内固定,19例使用LISS钢板内固定.55例采用自体髂骨植骨,3例在自体植骨的同时结合同种异体松质骨移植,3例采用同种异体松质骨结合人工骨移植.手术前、后根据膝关节协会评分系统(KSS)评分对47例膝关节周围骨不连患者的关节功能进行评估,85～100分为优,70～84分为良,60～69分为一般,＜60分为差.术前优29例,良8例,一般4例,差6例.结果 所有患者均获得随访,随访时间6～24个月,平均12个月;骨折均在4～6个月内牢固连接,平均愈合时间4.8个月,无内植物松动、断裂等并发症.术后膝关节KSS评分,优35例,良7例,一般1例,差4例.结论 锁定钢板内固定结合植骨术是治疗四肢长骨骨不连的有效方法.     

外固定支架治疗锁骨中段骨折的初步报告

目的 探讨应用外固定支架治疗锁骨中段骨折的疗效.方法 2002年6月至2009年5月应用外固定支架治疗7例锁骨中段骨折患者,男4例,女3例;年龄25 ～ 42岁,平均33.7岁.根据Edinburgh分型:均为Edinburgh 2B1型.5例合并多发伤的患者于伤后当天即接受锁骨骨折Orthofix单平面多轨道支架固定治疗,1例开放性锁骨骨折和1例锁骨感染性骨不连患者择期行HoffmanⅡ多平面框架式支架固定治疗.结果 所有患者术后获11～18个月(平均14.1个月)随访.外固定支架保留时间为53 ～90 d,平均64.4 d.患者末次随访时肩关节功能优良,Constant-Murley评分平均为94 3分.骨折均获骨性愈合.所有患者对其肩关节外观和治疗结果均表示满意.随访发现3例患者发生并发症:1例钉道瘢痕增生;1例术后复位丢失,骨折畸形愈合;1例钉道感染.结论 对于开放性骨折、感染性骨不连及部分合并有严重并发症,且无法耐受标准切开复位内固定术而又移位明显的锁骨中段骨折患者,应用外固定支架治疗能取得良好的疗效.     

Infected nonunion of the femur

From 1988 to 2000, 21 patients with infected nonunion were treated by wide resection of the nonunion site and fixation with Ilizarov's external ring fixator. Of the 21 cases, 2 are still under treatment. 18 cases resolved. In two cases iterative fracture occurred, which was successfully treated by internal fixation. One case treated by external fixator failed; any further attempts at surgery were abandoned, and the patient was put in a brace. The ring fixator enabled a sufficiently wide resection to remove the infection. It also provided stability for long periods of time, unrestricted weight bearing, and, after resolution, the same set up was used to restore the femur to its original length by corticotomy and distraction according to Ilizarov.