Ilizarov技术结合载万古霉素骨水泥治疗胫骨创伤后骨感染合并骨与软组织缺损的疗效

目的 探讨Ilizarov骨搬运技术结合载万古霉素骨水泥垫块在胫骨创伤后骨感染合并骨与软组织缺损中的疗效.方法 采用回顾性病例系列研究分析2016年6月至2019年6月安徽医科大学第一附属医院收治的11例胫骨创伤后骨感染合并骨与软组织缺损患者临床资料,其中男7例,女4例;年龄21 ～56岁(41.5±12.1)岁]....

Ilizarov technique combined with vancomycin bone cement for treatment of posttraumatic tibial bone infection combined with bone and soft tissue defects

Objective To investigate the effect of lizarov bone transport technique combined with vancomyein bone cement for treatment of posttraumatic tibial bone infection combined with bone and soft tissue defects.Methods A retrospective case series study was performed on 11 patients with posttraumatie tibial bone infection combined with bone and soft tissue defects admitted to First Affiliated Hospital of Anhui Medical University fom June 2016 to June 2019.There were 7 males and 4 females,with age of 21-56 years.(41.5±12.1)years].Afer debridement,the length of bone defect was 4-13.2 cm(8.1±2.6)cm],and the area of soft tissue defect was 6.5-23.4 cm²(16.2±4.7)cm²].All patients were treated firstly with debridement of bone infection and vancomyecin loaded bone cement pad flling,followed by lizarov technique to repair bone and soft tissue defects.The soft tissue docking time,fracture docking time,extemal fixation time and extermal fixation index were recorded.At the last follow-up,Johner wruhs score was used to evaluate the curative ffect and American Orthopedic Foot and Ankle Society(AOFAS)ankle hindfoot score to evaluate the ankle joint function.The postoperative complications were observed.Results All patients were fllowed up for 17-23 months(17.9±4.5)months].The soft tssue docking time was 48-155 days(101.7±29.0)days]and fracture docking time was 55-167 days(111.6±29.5)days].The extemal fixation time was 154-450 days(322.9±86.3)days]with an extemal fixation index of 31.1-61.5 cn/day(40.8+7.5)cm/day].At the last fllow-up,the results were excellent in 2 patients,god in4 and fair in 5 based on Johner-Wruhs score.At the last follow-up,the AOFAS ankle hindfoot score was 61-94 points(76.6±12.7)points],with excellent results in 3 patients,good in 2 and fair in 6.Four patients were treated with secondary operation,and two of them bad docking site nonunion which healed after secondary bone grafting.No free or local transposition flap repair was performed in regadless of soft tssue defect.During the follow-up,there were no complications such as fever,wound weeping,soft tissue necrosis or neurovascular injury.Conclusion For posttraumatic tibial bone infection combined with bone and soft tissue defects,the Ilizarov bone transport technique combined with vanomyein-oaded bone cement has advantage of shorter operation time,trauma and complications,and can achieve bone lengthening and soft tissue healing simultaneously.