手风琴技术用于骨搬移治疗胫骨骨缺损

目的 :分析Ilizarov技术治疗胫骨大段骨缺损时加用"手风琴技术"的临床治疗效果。方法 :2014年1月至2016年6月采用Ilizarov骨搬移技术治疗胫骨大段骨缺损患者22例,男19例,女3例;年龄23~60岁,平均44.04岁;骨搬移前骨缺损长度5~11 cm,平均7.68 cm;14例交通事故,3例摔伤,4例砸伤,1例高处跌落;左侧6例、右侧16例。分成两组,手风琴组搬移结束后实施手风琴技术11例,对照组搬移结束后外架锁定等待矿化11例。两组患者均获得随访,随访时间18~36个月,平均27.9个月。两组患者性别、年龄、骨缺损的长度比较,差异均无统计学意义(P0.05)。分析愈合时间、愈合指数等指标,并采用Paley等方法评价骨愈合和患肢功能恢复的治疗效果。结果:两组X线评价均达到骨性愈合;手风琴组:骨愈合时间(365±91)d,愈合指数(46.2±3.5)d/cm;对照组:愈合时间(435±108)d,愈合指数(57.8±3.5)d/cm;两组骨愈合时间比较,差异无统计学意义(t=1.648:P=0.115);两组骨愈合指数比较,差异有统计学意义(t=7.754,P=0.000)。末次随访时依据Paley评价标准评价疗效:实验组优9例,良2例;对照组优8例,良3例;两组比较差异无统计学意义(Z=-0.479,P=0.619)。并发症:钉道感染:手风琴组9例,对照组10例;局部牵拉痛:手风琴组2例,对照组1例;轴向偏移10°:手风琴组4例,对照组3例;骨缺损汇合端对位差:手风琴组3例;对照组2例;两组并发症比较差异无统计学意义(P0.05)。结论 :Ilizarov骨搬移技术治疗胫骨骨缺损时加用"手风琴技术"操作后可缩短治疗时间和矿化时间,提高愈合指数。

Accordion operation for the bone transport in treating tibial bone defect

Objective: To discuss clinical outcomes of accordion operation for the Ilizarov technique in treating tibial bone defects.Methods: From January 2014 to June 2016,22 patients with tibial bone defects were treated by Ilizarov bone-transport technique,including 19 males and 3 females with an average age of 44.04 years old ranging from 23 to 60 years old;the length of the bone defects before the bone transport was 5 to 11 cm with an average 7.68 cm;Cause of injury invlved traffic accidents in 14 cases,fall injury in 3,smashing injury in 4,high drop injury in 1;6 cases were on the left and 16 cases were on the right. The patients were divided into two groups:11 cases in accordion group were treated by "accordion operation" after bone transport was completed;11 cases in control group were treated by the external fixator locked waiting for bone consolidation after bone transport was completed. All patients were followed up for 18 to 36 months with an average time of 27.9 months. There was no statistical significance between two groups,such as sex,age,length of bone defect(P>0.05). Analysis of healing time,healing index and other indicators,and Paley''s criterion was used to evaluate the healing effect of bone healing and function recovery of the limb.Results: The result of X-ray evaluation was all patients achieved bone healing. In accordion group,the bone healing time was (365±91) days,the bone healing index was (46.2±3.5) d/cm; in control group,the bone healing time was(435±108) days,the bone healing index was (57.8±3.5) d/cm. There was no statistical significance in the bone healing time between the two groups(t=1.648,P=0.115);There was statistical significance in the bone healing index between the two groups(t=7.754,P=0.000). At the final follow-up,according to Paley''s criterion,the result in accordion group was excellent in 9 cases,good in 2 cases;in control group,excellent in 8 cases,good in 3 cases. Score was not statistically significant(z=-0.479,P=0.619). Complications involved nail infection (9 cases in accordion group,10 cases in control group);local traction pain (2 cases in accordion group,1 case in control group); axial malalignment>10°(4 cases in accordion group,3 cases in control group);location difference of the junction of bone defects (3 cases in accordion group,2 cases in control group);Complications were not statistically significant(P>0.05).Conclusion: Accordion operation for the Ilizarov technique in treating tibial bone defects can shorten the treatment time and consolidation time,and improve the healing index.