Ilizarov技术治疗胫骨骨缺损的优势及改进策略

文题释义：骨搬移技术：将Ilizarov环形外固定架与胫腓骨坚强固定后，在胫骨骨缺损的远端或近端截骨，形成滑移骨段；按照既定调节速率牵拉滑移骨段，向骨残端靠近，逐步填充骨缺损区；在牵拉应力的作用下，机体再生信号系统被激活，新生骨痂逐渐产生、增多、聚集、矿化、塑性，填补搬移区，最终治愈骨缺损。 手风琴技术：基于牵拉组织再生技术衍生出的手风琴技术，改变了原有的单纯的牵拉应力，在此基础上引入压缩应力，使断端受到交替性的牵拉-压缩应力刺激，从而刺激新骨及血管再生，以期达到断端骨愈合的目的。 背景：Ilizarov技术在治疗胫骨骨缺损方面优势明显，可用于治疗各种类型的胫骨骨缺损，但该技术仍存在诸多不足，急待解决。 目的：就Ilizarov技术治疗胫骨骨缺损的优势、不足及改进策略进行综述。 方法：第一作者应用计算机检索1971至2019年PubMed、CNKI及万方数据库，以“bone defect，bone transport，accordion maneuver，ultrasonography，energy spectrum CT，pin site infection”为英文检索词，以“胫骨骨缺损，骨搬移技术，手风琴技术，超声，能谱CT，针道感染”为中文检索词，最终纳入符合标准的文献57篇，并以此对Ilizarov技术治疗胫骨骨缺损的优势、不足及改进策略作一综述。 结果与结论：①Ilizarov技术在治疗胫骨大段骨缺损、合并软组织损伤、感染及畸形的胫骨骨缺损方面优势明显；②对于骨搬移技术的并发症，如针道感染、搬移区新骨矿化不良、对合端愈合困难等问题，可采用新的消毒剂、手风琴技术并结合彩色多普勒超声及能谱CT等辅助检查来解决，从而降低并发症的发生率；③仍需改善现有的治疗技术或选择新的方法来进一步减少并发症的发生。 ORCID: 0000-0003-3985-1091(贺国宇) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Advantages and improvement strategies of Ilizarov technique in the treatment of tibial bone defect

BACKGROUND:Ilizarov technique has obvious advantages in the treatment of tibial bone defect and can be used to treat various types of tibial bone defect.However,there are still many shortcomings in this technology,which need to be solved urgently.OBJECTIVE:To review the advantages,shortcomings and improvement strategies of Ilizarov technique in the treatment of tibia bone defect.METHODS:PubMed,CNKI and Wanfang databases from 1971 to 2019 were retrieved with the key words of“bone defect,bone transport,accordion maneuver,ultrasonography,energy spectrum CT,pin site infection”in English and Chinese,respectively.Totally 57 eligible articles were included to systematically summarize the advantages,shortcomings and improvement strategies of Ilizarov technique in the treatment of tibia bone defect.RESULTS AND CONCLUSION:(1)Ilizarov technology has obvious advantages in the treatment of the tibia bone defect,combined with soft tissue injury,infection and deformity of the tibia bone defect.(2)New disinfectants,accordion technology,color Doppler ultrasound and energy spectrum CT are effective treatment methods for complications of bone transport technology,such as pin site infection,poor mineralization of new bone in the transfer area,and difficulty in healing at the docking site.These methods can reduce the incidence of complications.(3)It is still necessary to improve the existing treatment techniques or choose new methods to further reduce the incidence of complications.