Ilizarov骨搬运技术结合病灶截骨治疗Cierny-Mader Ⅳ型慢性胫骨骨髓炎北大核心CSCD

目的探讨Ilizarov骨搬运技术结合病灶截骨清创、置管冲洗治疗合并骨缺损的Cierny—MaderIV型慢性胫骨骨髓炎的疗效。方法对2010年1月至2016年5月收治的39例Cierny—Mader1V型慢性胫骨骨髓炎患者资料进行回顾性分析,男33例,女6例;年龄8～54岁,平均33．8岁。清创并于病灶处截骨,采用2／3环外固定支架固定,于胫骨远或近干骺端截骨进行骨搬运,本组患者2处截骨11例,近端截骨21例,远端截骨7例,术后3～5d于截骨端起始进行骨搬运,速度为0．5～1．0mm／d,中后期根据骨折愈合及疼痛情况调整骨搬运速度,术后每2周摄x线片观察骨搬运情况,并及时调整。患者搬移时间为50～130d,平均62．4d。结果39例患者术后获11～49个月（平均21个月）随访。软组织缺损创面全部愈合,骨髓炎无复发。32例患者骨断端、延长区一期愈合,5例患者出现骨断端不愈合,2例患者出现骨延长区成骨不良,上述7例患者经二期植骨术后骨折愈合。5例患者发生对合不良,其中4例经及时调整后对合良好;1例无法调整,行断端植骨术后愈合。7例患者出现踝关节跖屈畸形,背伸障碍,其中5例予以功能锻炼后好转;2例功能锻炼效果不佳,拒绝手术松解,残留踝关节功能障碍。9例患者出现不同程度针道感染,其中1例因感染重予以拔除克氏针,局部麻醉下更换克氏针好转;其余均经加强换药好转。结论Ilizarov骨搬运技术结合病灶断端大段截骨可有效治疗Cierny—Mader Ⅳ型慢性胫骨骨髓炎。但由于多种并发症的存在,应在充分了解Ilizamv技术的基础上不断改进该技术,同时加强术后宣教和护理,定期随访,可大大降低并发症的发牛。     

胫骨近端与远端骨搬移治疗骨髓炎骨缺损的比较

[目的]探讨胫骨近端与远端骨搬运在骨髓炎治疗中的疗效差异.[方法]选取本院60例慢性胫骨骨髓炎患者作为研究对象,分为近端和远端截骨搬运组,对比两组患者的下床时间、带架时间、带架期间VAS评分、疗效、EFI评分、AOFAS评分、ROM评分以及术后出现的不良反应.[结果]近端截骨搬运组患者的下地时间、带架期间的VAS评分和...     

骨搬运治疗胫骨慢性骨髓炎,是否需要加用抗生素骨水泥?

[目的]探讨加用抗生素骨水泥能否减少骨搬运技术治疗胫骨慢性骨髓炎的复发率。[方法]将18例胫骨慢性骨髓炎的患者随机分为两组,一组为对照组,10例,不使用抗生素骨水泥,用油纱填塞骨缺损处;骨水泥组8例,在骨缺损处填充万古霉素骨水泥(20 g骨水泥加入3 g万古霉素)。骨段搬运的过程中,骨缺损处的空间越来越小,逐渐拉出骨水泥链珠或油纱。根据Paley等感染性骨缺损评分标准评定疗效。[结果]10例对照组中的1例出院后失访,其余17例术后获12~47个月(平均31个月)随访,所有的患者感染治愈。骨水泥组平均创口闭合时间为63 d,对照组平均创口闭合时间为69 d;骨缺损端愈合时间骨水泥组平均4.4个月,对照组平均4.3个月。并发症包括钉道感染:骨水泥组7例,对照组9例;>10°的力线偏移:骨水泥组5例,对照组3例,均在随访过程中纠正;关节僵硬:骨水泥组1例,对照组2例;根据Paley感染性骨缺损的评分标准:骨水泥组优7例,良1例,对照组优7例,良2例。两组间比较差异无统计学意义。[结论]即使在骨缺损处不填充抗生素骨水泥,通过彻底清创,骨搬运技术可以很好的治疗胫骨慢性骨髓炎。     

外固定支架治疗胫骨骨折内固定术后骨髓炎及软组织缺损

目的：使用外固定支架治疗21例骨折内固定术后骨髓炎或软组织坏死缺损的患者，总结用外固定支架治疗这类疾病的临床规律。方法：用单侧多功能外固定支架，治疗21例内固定术后出现感染或软组织坏死缺损的患者，术中拆除内固定材料，清除骨髓炎病灶，用旋转皮瓣、肌瓣转移、植皮、髂骨植骨等方法，术前术后用敏感抗菌素。结果：病人骨髓炎症状消失，2例需再次髂骨植骨，3个月－1年内拆除外固定支架，无1例截肢。优良率71．4％。结论：使用外固定支架治疗内固定术后骨髓炎或软组织坏死缺损的病人，可有效地消除骨髓炎，并同时保持骨折的稳定性，保证骨折顺利愈合。     

胫骨截骨骨延长治疗小腿骨缺损感染

目的介绍胫骨截骨骨延长方法修复小腿骨与软组织同时缺损的临床经验。方法2002年6月～2003年12月采用Ilizarov型组合外固定架固定治疗18例小腿骨与软组织缺损感染患者,骨坏死缺损长度为4～12mm,平均5．6mm。对骨缺损处彻底清创,尽最大限度覆盖创面,在小腿近侧干骺端处行水平截骨,骨段牵移直到与远骨折端接触并加压固定。结果所有患者术后获5～24个月(平均14．5个月)随访,全部患者创面均得到良好的软组织覆盖,骨延长与缺损处骨性愈合,膝关节功能正常,踝关节维持术前状态,未发生神经、血管损伤。结论小腿截骨骨延长修复术治疗创伤后小腿骨、皮缺损感染疗效良好。     

骨搬运联合锁定钢板与传统骨搬运术治疗胫骨骨缺损的疗效比较北大核心CSCD

目的 探讨骨搬运联合锁定钢板(bone transport with a locking plate,BTLP)与Ilizarov支架或Orthofix支架行传统骨搬运术治疗胫骨骨缺损的疗效差异。方法 回顾分析2016年1月—2020年9月符合选择标准的60例胫骨开放性骨折患者临床资料,患者分别采用BTLP(BTLP组,n=20)、Ilizarov支架(Ilizarov组,n=23)、Orthofix支架(Orthofix组,n=17)进行骨搬运治疗。3组患者性别、年龄、致伤原因、受伤至入院时间、胫骨骨折分型、骨缺损长度以及合并症等一般资料比较,差异均无统计学意义(P>0.05)。比较3组截骨延长术手术时间、骨搬运支架带架时间、外固定指数及术后并发症发生情况;骨重建完成(拆除支架)后,采用Ilizarov方法应用研究学会(ASAMI)评价标准评定骨愈合及功能恢复情况。结果 3组患者均获随访,随访时间13~45个月,平均20.4个月。BTLP组截骨延长术手术时间短于Ilizarov组,骨搬运支架带架时间及外固定指数均低于Ilizarov组和Orthofix组,差异均有统计学意义(P<0.05)。Ilizarov组骨折愈合22例、延迟愈合1例,Orthofix组分别为16、1例,BTLP组分别为18、2例,组间比较差异无统计学意义(P=0.824)。骨重建完成后根据ASAMI评价标准,BTLP组骨愈合评价优于Orthofix组,功能评价优于Ilizarov组,差异有统计学意义(P<0.05)。术后BLTP组4例(20%)、Ilizarov组18例(78%)、Orthofix组12例(70%)发生并发症,BTLP组并发症发生率低于Ilizarov组和Orthofix组(P<0.05)。结论 BTLP治疗胫骨骨缺损安全、有效,并且在截骨延长术手术时间、外固定指数、患肢功能恢复方面较传统骨搬运术有明显优势。     

组合式支架在胫骨近端截骨术中的应用

目的：探讨膝内外翻畸形,胫骨高位截骨术纠正下肢负重力线,方法：对胫骨近端施行胫骨高位载骨术,组合式支架固定36例,结果：全部获－14年随访,1年优良率97．5％,2年优良率95％,4年优良率87．5％,结论：组合式支架应用于胫骨近端截骨术中,截骨处愈合时间明显缩短,无关节僵 及肌肉萎缩,不需石膏及内固定物固定,术后X线片显示股胫关节内或外侧间隙较术前增宽,关节退变明显改变,关节疼痛消失。     

胫骨创伤性骨髓炎骨不连治疗体会

<正>胫骨创伤后骨髓炎在临床上比较常见。胫骨前软组织少,血液循环差。一旦下肢骨折,同时存在皮肤软组织坏死缺损,下肢高度肿胀或胫骨外露,手术后易引起切口感染[1]。1998年6月至2008年12月,本院对16例胫骨创伤后骨髓炎,在彻底清创的基础上,外固定加压治疗疗效满意。现总结报道如下。     

胫骨亚高位截骨外固定治疗中老年膝关节骨性关节炎

目的 评价胫骨亚高位截骨外固定治疗中老年膝关节性关节炎的疗效。方法 选择伴有膝内翻畸形的中老年膝关节节骨折性关节炎２７例共５３膝,采用轻前入路,胫骨 结节水平骨膜下∩形截骨,矫正畸形,于胫骨平台下及踝上穿斯氏针,安装外固定器固定。结果 术后平均随访６．４,优３３膝（６２．３％）,良１７膝（３２％）,可３膝（５．７％）。结论 胫骨亚高位截骨外固定治疗伴膝内翻的中老年膝关节性关节炎,保留了胫骨高位截骨     

病变切除外固定支架固定及膜诱导技术治疗胫骨骨折术后骨髓炎

目的 :研究病变切除外固定支架固定结合膜诱导技术治疗胫骨骨髓炎的临床疗效。方法 :自2011年6月至2014年6月手术治疗13例胫骨骨髓炎患者,其中男8例,女5例;年龄16~67岁,平均(37.3±14.3)岁。Ⅰ期病变切除,抗生素骨水泥植入,外固定支架固定,6~8周诱导膜形成后Ⅱ期手术取出骨水泥,植骨并利用膜诱导技术修复骨缺损促进骨质愈合。结果:随访24~52个月,13例感染无复发,骨质均获愈合,功能恢复良好。结论:采用病变切除外固定架固定及膜诱导技术治疗胫骨骨折术后骨髓炎可以取得很好的治疗效果。     

腓骨横向搬移治疗胫骨大段骨缺损

目的 探讨应用腓骨横向搬移术治疗胫骨大段骨缺损的方法与疗效.方法 2004年4月至2009年10月收治4例胫骨大段骨缺损患者,男3例,女1例;年龄14～62岁,平均27岁.胫骨缺损长度为13～25 cm.采用环形外同定支架固定,腓骨远、近端分别截骨后用2根橄榄针穿过腓骨固定于牵引器上,术后逐渐牵拉腓骨至胫骨骨缺损区,并于断端取髂骨植骨.结果 所有患者术后获12～60个月(平均34.6个月)随访.4例患者应用腓骨横向搬移修复胫骨大段骨缺损均获成功,治疗时间(安装外固定支架至拆除外固定支架时间)为12～26个月,平均19个月.全部患者伤口愈合良好,无感染复发,牵引过程中无神经损伤等并发症发生.2例患者有针道感染,均为表浅软组织感染,无需特殊处理,拔除牵引针后愈合.随着负重行走等功能锻炼,腓骨逐渐增粗,未发生再骨折.患肢功能恢复良好,均能完全负重行走.结论应用Ilizarov外固定支架进行腓骨横向搬移是治疗胫骨大段骨缺损的有效方法.

Abstract：

Objective To explore the therapeutic effects of ipsilateral fibular transport with an Ilizarov frame for treatment of massive tibial bone loss. Methods From April 2004 to October 2009, 4 cases of massive tibial bone loss were treated with an Ilizarov frame and ipsilateral fibular transport. They were 3 men and one woman, aged from 14 to 62 years (average, 27 years). Their tibial losses ranged from 13 to 25 cm. The whole tibia was first fixed with an external Ilizarov ring frame. Osteotomy was then performed at both distal and proximal parts of the fibula, before the isolated fibula was fixed to the Ilizarov frame with 2 olive wires. Next, the isolated fibula was gradually distracted to the site of tibial bone loss at a speed of one mm per day. Bone grafts were transplanted where and when the isolated fibula touched the tibia at last. Results The 4 patients were followed up for an average duration of 34. 6 months (range, 12 to 60 months). The external fixation time ranged from 12 to 26 months, (average, 19 months). Two patients had superficial pin site infection during fibular transport and healed spontaneously after removal of the pins. All the wounds were completely healed and no wound infection recurred. No nerve injury occurred during the fibular distraction.After full-weight bearing exercise, the isolated fibula became thicker gradually and no refracture happened.All patients regained good walking with full weight-bearing. Conclusion Gradual ipsilateral fibular transport with an Ilizarov frame is a reasonable and effective therapeutic method for patients with massive tibial bone loss.     

Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects

IntroductionThis study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10 cm in length.MethodsIn a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10 cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates.ResultsThe mean size of the bone defect was 7 cm in Group A, and 5.8 cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P = 0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P = 0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P = 0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P = 0.28).ConclusionsWhile both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures.Level of evidence: Level III; Retrospective comparative study     

外固定支架骨转移技术治疗股骨干骨髓炎大段骨缺损

目的:探讨应用外固定支架骨转移技术治疗股骨干骨髓炎大段骨缺损的临床疗效及优势.方法:2008年8月至2013年12月收治股骨干骨髓炎合并有大段骨缺损病例16例,男11例,女5例;年龄13~62岁,平均42岁;病程2个月~4.5年,平均18个月;骨缺损长度4.5~15 cm,平均7.8 cm.全部病例应用外固定架骨转移技术治疗骨缺损,术后1周开始骨转移,每天1 mm,分4次进行.结果:全部病例均获得随访,时间10~36个月,平均22.5个月.16例中1例患者由于不配合治疗,致治疗失败,后采取截肢术.余15例骨髓炎均得到控制,其中12例骨转移达到Ⅰ期骨愈合,3例骨转移远端不能Ⅰ期愈合予以自体髂骨植骨后达到骨愈合,骨愈合时间5~13个月,平均7.9个月.13例患者双下肢长度基本一致,2例患者有1.5~2.0 cm肢体短缩畸形存在.外固定架拆除时间6~16个月,平均9.3个月.结论:应用外固定支架骨转移技术是治疗股骨干骨髓炎大段骨缺损的有效方法之一,可控制感染,消灭创面,均衡肢体长度.     

骨搬运技术治疗胫骨骨缺损疗效及影响因素分析

目的探讨骨搬运技术治疗胫骨骨缺损的临床疗效及影响因素。方法回顾性分析自2006-03—2014-10诊治的46例胫骨骨缺损,按照手术方式不同分为观察组(采用骨搬运技术治疗)和对照组(采用单臂外固定架手术治疗)。比较2组骨愈合指数、AKS膝关节、Baird踝关节功能、Fernandez-Esteve骨痂评分,观察组疗效采用多因素Logistic回归分析。结果所有患者均获得11~25(18.7±7.2)个月随访。观察组骨愈合指数低于对照组,但AKS膝关节、Baird踝关节功能、Fernandez-Esteve骨痂评分高于对照组,差异均有统计学意义(P0.05)。观察组的疗效回归分析显示,肢体负重开始时间(OR=1.10,P=0.002)、骨搬运速度(OR=1.07,P=0.010)、骨搬运频率(OR=1.17,P=0.021)评分是骨愈合指数评分的保护性因素,吸烟(OR=0.89,P=0.006)、骨缺损长度(OR=0.96,P=0.000)、年龄(OR=0.87,P=0.000)评分是骨愈合指数评分的危险性因素,差异有统计学意义(P0.05);对合端接触面积(OR=1.21,P=0.001)、肢体负重开始时间(OR=1.19,P=0.001)、负重持续总计时间(OR=1.06,P=0.005)评分是骨痂评分保护性因素,差异有统计学意义(P0.05)。结论骨搬运技术治疗胫骨骨缺损在骨愈合、骨延长速度、重建下肢肢体长度和功能方面有更好的评价。     

Ilizarov技术骨短缩-延长治疗无血管损伤的胫骨与软组织缺损

目的探讨Ilizarov技术骨短缩-延长治疗无血管损伤的胫骨与软组织缺损的疗效。方法回顾性分析2007年1月至2017年10月无锡市第九人民医院骨科采用Ilizarov技术骨短缩-延长治疗的28例无血管损伤的胫骨与软组织缺损患者资料。男20例,女8例;年龄18~69岁,平均36.4岁。均为创伤性骨折,GustiloⅡ型5例,ⅢA型6例,ⅢB型17例。17例合并感染。清创或扩创后创面皮缺损范围4 cm×3 cm^16 cm×5 cm,骨缺损长度4.5~11.0 cm(平均6.9 cm)。急性短缩3~7 cm后直接缝合或局部皮瓣转移或游离植皮,或术后逐渐短缩创口延迟闭合。术后观察创口愈合、骨愈合、下肢功能恢复和并发症等情况。骨愈合和下肢功能恢复分级按照Ilizarov技术研究与应用学会(ASAMI)标准分别评定。Ilizarov手术相关并发症按照Paley标准分为主要和次要并发症。结果创口愈合时间13~35 d(平均21.9 d),缺损端靠拢时间为0~75 d(平均21.8 d)。所有患者术后获12~45个月(平均20.5个月)随访。延长段骨愈合时间6~12个月(平均8.9个月);缺损端1例骨不连,骨愈合时间6~11个月(平均8.3个月)。ASAMI骨愈合分级优良率为100%(28/28),ASAMI下肢功能恢复优良率为89.3%(25/28)。Ilizarov术后主要并发症发生率为14.3%(4/28),次要并发症发生率为57.1%(16/28),总体并发症发生率为60.7%(17/28),并发症人次平均为1.7个/例。结论Ilizarov技术骨短缩-延长治疗无血管损伤的胫骨与软组织缺损,可以解决皮肤等软组织缺损修复困难难题,具有简化创口闭合、骨缺损端骨愈合较快、愈合率较高、并发症相对较少和肢体功能恢复满意等特点。     

两种不同外固定支架治疗胫骨远端骨折的疗效比较

目的 比较两种不同外固定支架治疗胫骨远端骨折的疗效.方法 对2005年8月至2010年2月分别采用跨关节单边外固定支架和双边组合式外固定支架治疗并获得随访的38例胫骨远端骨折患者资料进行分析,其中单边外固定支架组(A组)23例,男16例,女7例;年龄24～64岁,平均46.5岁;双边外固定支架组(B组)15例,男11例,女4例;年龄32～65岁,平均49.1岁,记录骨折愈合时间、并发症发生率,并按照美国足踝外科协会(AOFAS)的标准评价踝关节功能,比较两组患者的疗效.结果 所有患者术后获6～48个月(平均21个月)随访.骨折愈合时间:A组为3.5～12个月,平均(6.8±2.0)个月;B组为3～10个月(平均5.6±1.5)个月,两组比较差异有学意义(t=2.074,P=0.046).按照AOFAS标准进行评分:A组平均为(76.7±13.5)分,外固定期间并发症发生率为34.8%(8/23);B组平均为(74.4±13.6)分,外固定期间并发症发生率为40.0%(6/15).两组并发症发生率与AOFAS评分比较差异无统计学意义(P>0.05).结论 单边外固定支架固定与双边组合式外固定支架固定均是治疗胫骨远端骨折的有效固定方式,在骨折愈合的时间方面,双边外固定支架较单边外固定支架具有优势.

Abstract：

Objective To compare unilateral and bilateral external fixators in the surgical treatment of fractures of distal tibia. Methods From August 2005 to February 2010, 38 patients with distal tibial fracture were treated surgically in our department. Of them, 23 (group A) were fixed with unilateral external fixator (16 males and 7 females with a mean age of 46. 5 years), and 15 (group B) fixed with bilateral external fixator (11 males and 4 females with a mean age of 49. 1 years) . All the patients were followed up periodically after operation. Time of fracture healing, complications, the American Orthopaedic Foot and Ankle Society (AOFAS) scores for the ankle were documented and analyzed statistically to compare the clinical outcomes of the 2 groups. Results The patients were followed up for 6 to 48 months (mean, 21 months).The mean time for clinical fracture union was 6. 8 ± 2. 0 months (3. S to 12. 0 months) for group A, and 5. 6 ± 1. 5 months (3 to 10 months) for group B. The complication rates during external fixation were 34. 8% (8/23) for group A and 40.0% (6/15) for group B. The AOFAS scores for functional recovery were 76. 7 ± 13. 5 for group A and 74. 4 ± 13. 6 for group B. Independent samples t test showed a significant difference ( P < 0. 05) between the 2 groups in time of clinical fracture union, but no significant difference (t = 2. 074, P = 0. 046) in complication rates and AOFAS scores. Conclusion Both unilateral and bilateral external fixators are effective for fixation of distal tibial fractures, but bilateral external fixators may be better in time of fracture healing.     

Bone transport through an induced membrane in the management of tibial bone defects resulting from chronic osteomyelitis

Wide resection of infected bone improves the odds of achieving remission of infection in patients with chronic osteomyelitis. Aggressive debridement is followed by the creation of large bone defects. The use of antibiotic-impregnated PMMA spacers, as a customized dead space management tool, has grown in popularity. In addition to certain biological advantages, the spacer offers a therapeutic benefit by serving as a vehicle for delivery of local adjuvant antibiotics. In this study, we investigate the efficacy of physician-directed antibiotic-impregnated PMMA spacers in achieving remission of chronic tibial osteomyelitis. This retrospective case series involves eight patients with chronic osteomyelitis of the tibial diaphysis managed with bone transport through an induced membrane using circular external fixation. All patients were treated according to a standardized treatment protocol. A review of the anatomical nature of the disease, the physiological status of the host and the outcome of treatment in terms of remission of infection, time to union and the complications that occurred was carried out. Seven patients, with a mean bone defect of 7 cm (range 5–8 cm), were included in the study. At a mean follow-up of 28 months (range 18–45 months), clinical eradication of osteomyelitis was achieved in all patients without the need for further reoperation. The mean total external fixation time was 77 weeks (range 52–104 weeks), which equated to a mean external fixation index of 81 days/cm (range 45–107). Failure of the skeletal reconstruction occurred in one patient who was not prepared to continue with further reconstructive surgery and requested amputation. Four major and four minor complications occurred. The temporary insertion of antibiotic-impregnated PMMA appears to be a useful dead space management technique in the treatment of post-infective tibial bone defects. Although the technique does not appear to offer an advantage in terms of the external fixation index, it may serve as a useful adjunct in order to achieve resolution of infection.     

胫骨骨搬移后再骨折的临床观察

目的:基于采用Ilizarov骨搬移技术治疗胫骨骨缺损后发生再骨折的19例患者的临床资料,总结分析该类患者的临床特点及治疗效果。方法:回顾性分析2010年8月至2020年1月应用Ilizarov骨搬移技术治疗后发生再骨折的19例胫骨感染性骨缺损患者的临床资料,其中男18例,女1例;年龄15~66(37.7±13.0)岁。再骨折致伤原因:摔伤4例,砸伤1例,撞伤1例,无明显外伤史13例。再骨折发生的时间:2例外固定架尚未拆除时,发生同侧股骨远端骨折;其余17例最短1 d,最长30个月。再骨折部位:再生区8例,对接点9例,同侧股骨干2例。按笔者新提出的改良Simpson分型进行再骨折分类,再骨折治疗方法包括石膏托固定、牵引或外固定架固定。采用Ilizarov方法研究与应用学会(Association for the Study and Application of the Method of Ilizarov,ASAMI)标准进行骨愈合与功能评价。结果:所有患者获得随访,时间9~17(12.3±3.2)个月。按改良Simpson分型:Ⅰa型3例,Ⅰb型1例,Ⅰc型3例,Ⅱ型1例,Ⅲ型9例,Ⅴ型2例。所有再骨折愈合,无一例发生感染。保守治疗6例,骨折愈合时间分别为3、5、3、2、2、2个月,其中1例发生成角约20°的畸形愈合。手术治疗13例,骨折愈合时间为2~6(4.4±1.4)个月。按ASAMI评分标准:骨愈合均为优。功能结果优6例,良13例,其主要原因为踝关节或膝关节僵直。结论:新的改良Simpson分型与骨搬移后再骨折的临床实际类型更为贴切,对临床治疗方式的选择有一定的指导意义,外固定架治疗再骨折是一个简单、有效的方法。