骨搬移治疗胫骨骨缺损相关并发症的防治

目的 :探讨骨搬移治疗胫骨骨缺损相关并发症的预防与治疗方法。方法 :2012年1月至2015年6月应用骨搬移技术治疗38例胫骨骨缺损患者,男26例,女12例;年龄36~66岁,平均49.0岁;均为开放性胫骨骨折。38例患者骨缺损长度为4~9.6 cm,平均5.2 cm,术后及时调整力线及搬移速度,患者坚持负重。结果 :38例患者术后均获随访,时间17~36个月,平均24.0个月。19例患者对合端自然愈合,其余18例分别经手风琴技术(10例)、植骨辅助内固定(8例)相应处理后愈合。1例患者因神志不清、肺炎、膝关节脱位、糖尿病、脑瘫后遗症等难以护理,患者家属强烈要求手术截肢,故予以截肢处理。骨搬移时间为4~10个月,平均7.1个月。搬移长度为5~11.6 cm,平均8.0 cm。根据Johner-Wruhs胫骨干骨折疗效评价标准:优11例,良18例,中6例,差3例。除1例截肢外,其余病例均治愈,无感染复发、再骨折等。结论:骨搬移法是治疗胫骨骨缺损的有效方法,但其存在许多并发症是限制其临床应用的主要因素,包括搬移距离过长时长骨力线的偏移(骨外露)、钉道感染、钢针松动、软组织下陷、膝踝关节功能丧失、牵张骨痂不长、对合端接触后骨不愈合等。

Prevention and treatment of the related complications of tibial fractures bone defect by bone transport

Objective: To explore the therapeutic methods for the prevention and treatment of tibial bone defect and bone transport related complications. Methods: From January 2012 to June 2015,38 cases of bone defect of tibia were treated by bone transport technique treatment,including 26 males and 12 females,with an average age of 49.0 years old ranging from 36 to 66 years old. All patients were open fractures. The length of bone defect of 38 patients was 4 to 9.6 cm with an average of 5.2 cm. The force line and bone carrying rate were adjusted in time after operation. Patients insisted on loading. Results: All patients were followed up for 17 to 36 months with an average of 24 months. Among them,19 patients got natural healing in involution end;the other 18 cases respectively got healing after accordion technology in 10 cases,auxiliary internal fixation of bone graft after corresponding processing in 8 cases,1 patient for dottiness,pneumonia,the knee joint dislocation,diabetes,cerebral palsy sequela was difficult to care,patients'' families urged amputation surgery,so the amputation processing. The time of moving the bone transport was 4 to 10 months with an average of 7.1 months. Move length was 5 to 11.6 cm with an average of 8.0 cm. According to tibial stem diagnostic criteria of Johner-Wruhs score,11 cases were excellent,18 cases were good,6 cases were moderate and 3 cases were poor. In addition to 1 case of amputation,the remaining cases were cured,no infection recurrence,re-fracture and so on. Conclusion: Bone transport method is an effective method for the treatment of bone defect of tibia,but the existence of many complications is to limit the clinical application of the main factors,including shifting when the distance is too long the long reprojected line offset(bone exposure),nail tract infection,pin loosening,subsidence of soft tissue,loss of function of knee and ankle joint,pull a callus is not long,the contact ends were nonunion.