Ilizarov骨搬移技术治疗胫骨大段骨缺损合并软组织缺损

目的 探讨Ilizarov技术Ⅰ期治疗胫骨大段骨缺损合并软组织缺损的可行性.方法 2003年9月-2010年9月收治胫骨大段骨缺损合并软组织缺损患者24例,均为胫骨开放性骨折(Gustilo Ⅲ B型20例,Gustilo Ⅲ C型4例).在患肢上安放Ilizarov外固定架.清创术后小腿胫前内侧软组织缺损10 cm×6 cm,胫骨骨缺损(8±4)cm.对15例胫骨骨缺损＜5 cm的患者使用Ⅰ期清创、腓骨截骨、胫骨缺损端加压.对9例胫骨缺损＞5 cm的患者采用Ⅰ期清创、骨运输-骨延长.对15例患者采用Ⅰ期清创,封闭创面或缩小创面、骨搬移,Ⅱ期清理皮肤嵌顿及清理骨折端.结果 所有患者随访10～24个月,平均14个月.骨缺损均得以重建,患肢肢体长度与健侧之差＜2 cm,骨折愈合,创面均闭合.1例术后出现腓总神经麻痹,术后3个月恢复.19例未通过额外手术进行修复.3例通过游离皮片植皮成活,2例通过局部旋转皮瓣修复覆盖创面.结论 Ⅰ期使用Ilizarov外固定架进行骨搬移肢体是治疗胫骨骨缺损合并软组织缺损的有效方法.

Ilizarov technique for treatment of large tibia bone defect combined with soft tissue defect

Objective To explore the feasibility of Ilizarov technique in managing large tibia defects combined with soft tissue defects.Methods A total of 24 patients with large tibial defects combined with soft tissue defects caused by compound open tibial fractures were fixed with Ilizarov technique from September 2003 to September 2010.All patients belonged to open tibial fractures,including 20 patients with Gustilo type Ⅲ B and four with Gustilo type Ⅲ C.After debridement,the soft tissue defect areas was 10 cm ×6 cm and the bone defect was(8 ±4)cm.Fifteen patients with tibial defects ＜5 cm were treated with one stage debridement,fibula resection and tibial defect end compression.The other nine patients with tibial defect ＞ 5 cm were managed by one stage debridement,bone transport and bone lengthening.Then,15 patients were treated with one stage debridement,wound closure or wound reduction,bone grafting treatment and second stage cleansing of the incarcerated skin and fracture end.Results All patients were followed up for average 14 months(10-24 months),which showed reconstruction of the bone defects,restoration of the limb length,fracture healing and less than 2 cm difference between health limb and contralateral limb.One patient experienced common peroneal nerve palsy after operation,but recovered three months later.Of all,19 patients recovered without extra surgery,three restored with skin graft and two received skin flap.Conclusion Ilizarov technique is an effective option for treating the tibial defects combined with soft tissue defects at one stage.