骨搬移、骨延长术治疗长骨慢性骨髓炎和感染性骨不连体会

目的探索分析IIizarov骨搬移、骨延长术治疗长骨感染和肢体短缩，以及感染所致骨折不愈合的临床疗效。方法回顾性分析2011年6月-2013年10月，用骨感染病灶清除、IIizarov外固定支架固定及骨干骺端截骨骨搬移和骨延长术治疗13例长骨感染、缺损的股骨、胫骨和腓骨慢性骨髓炎和感染性骨不连患者，其中股骨和胫骨慢性骨髓炎8例（伴股骨病理性骨折1例），感染性骨不连4例；腓骨慢性骨髓炎1例。结果13例患者感染均得到一期治愈，窦道愈合，骨搬移结合处正常愈合。其中2例出院后自行搬移过程中出现钉道感染（1例经再次清创后治愈，1例经清创后感染复发截肢），1例在骨愈合后发生再骨折，经髓内钉固定后骨折愈合。13例患者骨搬移长度5～13cm，平均7．5cm；13例患者中有11例骨搬移后双下肢等长，2例患侧下肢较健侧下肢短缩。所有患者未出现神经损伤。结论IIizarov骨搬移和骨延长技术是治疗长骨感染及感染性骨不连的一种有效办法，手术可祛除感染，治愈窦道，恢复肢体长度，从而解决患者痛苦，提高其生活质量。

Bone Transport and Bone Lengthening in the Treatment of Long Bone Chronic Osteomyelitis and Infectious Bone Nonunion

Objective To analyze the clinical efficacy of Ilizarov bone transport and bone lengthening in the treatment of long bone infection and limb shortening, and fracture nonunion caused by infection. Methods We retrospectively analyzed the clinical data of 13 patients with long bone infection, chronic osteomyelitis of the femur and tibia, and infectious bone nonunion, treated with infection focus removal, Ilizarov outer fixation, bone transport and bone lengthening between June 2011 and October 2013. Among the patients, 8 of them had chronic osteomyelitis of the femur and tibia, 4 had infectious bone nonunion, and one had chronic fibula osteomyelitis. Results All the 13 patients had a first-stage healing of the sinus tract and junctions. Among the patients who did the bone transport by themselves after being discharged from hospital, two had nail infections （one was cured after debridement, and the other underwent amputation after re-infection after debridement）. One had a re-fracture after the healing of the previous fracture, and was cured by intramedullary nailing. The length of bone transport in these 13 cases ranged from 5 to 13 cm, averaging 7.5 cm. After bone transport, 11 patients had equal length of the lower limbs, and the affected lower limb of the other two patients became shorter than before. No neural function damage occurred in all the patients. Conclusion Ilizarov bone transport and lengthening technique is an effective way to treat infections and bone defect of long bone, and it can improve patients＇ quality of life greatly.