Ilizarov骨搬移技术治疗胫骨感染性骨缺损合并软组织缺损

目的：探讨应用Ilizarov技术治疗胫骨感染性骨缺损合并软组织缺损的方法和临床疗效。方法自2008年3月至2012年3月共收治胫骨感染性骨缺损合并软组织缺损患者15例，男9例，女6例，平均38岁（23～54岁），手术清创后胫骨缺损平均7．7 cm （3．0～21．0 cm ），软组织缺损面积平均7．5 cm2（3．6～18．4 cm2）。应用llizarov技术安装外架及固定针，采用骨缺损端同步延长与加压固定、术中直接加压固定或快速加压固定后逐步延长。结果术后所有患者均获得8～36个月的随访（平均16．2个月），全部患者胫骨缺损在7～28个月获得重建，平均12．3个月。4例骨缺损端术后快速加压获得愈合。2例对合端接触后无骨愈合征象，采用“手风琴技术”，1例骨端愈合，另外1例无效后植骨愈合。9例大段骨缺损皮肤软组织卡压于骨搬运端之间，行皮肤修整断端清理，其中6例同期进行松质骨植骨。14例软组织缺损在骨搬移过程中创面逐渐缩小获得愈合，1例特大面积皮肤缺损经游离植皮后愈合。根据Paley评价标准，本组优12例，良2例，中1例，优良率93．3％。结论应用Ilizarov技术选择的合适的手术方式是治疗胫骨感染性骨缺损合并软组织缺损的有效方法。

Ilizarov technique for one-stage treatment of infected tibia defect with soft tissue defect

Objective To explore the application and the clinical curative effect of Ilizarov technique in infected tibia defect with soft tissue defect .Methods It was case series retrospective study .Fifteen patients (6 women ,9 men;age 23-54 ,average 38) with infected tibia defect combined soft tissue defect between March 2008 and March 2012 were treated with Ilizarov external fixa‐tion .The average length tibia defect was 7 .7 cm(3 .0 -21 .0 cm) ,The average area of soft tissue defect was 7 .5 cm2 (3 .6 -18 .4 cm2 ) .Ilizarov external fixation was applied in the operation .Results All 15 patients were followed up and the mean time was 16 .2 months (range ,8-36 months) .The average time of the bony healing was 12 .3 months (range ,7 -28 months) .The docking site was bony healing after rapid compression in 4 cases .The docking site was not bony healing in 2 cases .The docking site achieved bony healing by accordion technique in one case ,and bone grafting in the other case .The skin and hypodermis were embedded in the docking site in 9 cases .The skin and hypodermis were displaced in 3 cases ,and bone grafted at the same time in the other 6 cases . The soft tissue defect gradually become small and healed at last in the 14cases .One case with large soft tissue defect was cured by skin grafting .According to Paley′s evaluation criteria ,12 cases were excellent ,2 good ,1 moderate ,giving a good to excellent rate of 93 .3% .Conclusion Ilizarov technique is a safe and effective method to treat infected tibia defect with soft tissue defect which can completely debride infected lesions ,repair the soft tissue defect ,cure bone nonunion and restore the limb length .