Ilizarov技术治疗胫骨感染性骨缺损

目的 探讨应用Ilizarov技术治疗胫骨感染性骨缺损的临床疗效.方法 2008年1月-2012年12月,我科采用Ilizarov技术治疗胫骨感染性骨缺损患者315例,男性236例,女性79例;年龄14 ～ 72岁,平均35岁;病史2个月～10年,平均9个月.病变在胫骨上段86例,胫骨中段92例,胫骨下段137例;伴有软组织缺损146例.骨缺损长度2～ 18cm,平均8cm;随访时间1～6年,平均28个月.术后随访观察骨及软组织愈合及并发症情况.结果 315例感染均一期控制,未见骨髓炎复发,软组织缺损创面全部愈合.63例行胫骨短缩延长术患者均实现一期骨性愈合.252例行胫骨骨搬移术,147例骨断端一期骨性愈合;97例骨断端经二期植入髂骨松质骨后实现骨性愈合;8例骨延长区成骨不良,经髂骨植骨后全部愈合.8例出现足下垂畸形,15例出现钉道感染,2例拆除外固定架后出现再骨折,10例出现轴向偏移,上述患者经对症处理后均得到良好疗效.结论 对于胫骨感染性骨缺损患者,Ilizarov技术能同时实现感染病灶彻底清除、骨不连治疗、皮肤软组织修复以及均衡肢体长度,一期手术达到满意的治疗效果.

Treatment of infected bone defect of tibia by ilizarov technique

Objective To explore the treatment efficacy of ilizarov technique in infected bone defect of tibia.Methods Three hundred and fifteen patients （236 males and 79 females） with infected bone defect of tibia who underwent ilizarov technique from January 2008 to December 2012 were observed,their average age was 35 years old （range from 14-72 years old） and the average illness duration was 9 months （range from 2 months-10 years）.The infected defect occurred on the proximal tibia in 86 patients,shaft tibia in 92 patients and distal tibia in 137 patients.146 patients were with soft tissue defects.The average lengthening of bone defects was 8 cm （range from 2-18 cm） with duration of follow-up from 1 to 6 years （average of 28 months）.The healings of bone and soft tissue,surgical complications were observed postoperatively.Results Infections of all patients were cured and no recurrence was observed.Soft tissue defects were healed.One-stage bone healing was achieved in 63 patients who underwent short lengthening contraction and in 147/252 patients who performed bone transport.Among patients without one-stage bone healing,97 patients achieved secondary healing by iliac cancellous bone implanting at the bone stumps,8 patients at the lengthening areas.The foot drop deformity were developed in 8 patients,pin tract infections in 15 patients,2 patients were fractured again after removing the external fixators,and bone segmental axial deviation in 10 patients.All patients with complications underwent the corresponding treatments and achieved good results.Conclusion Completely debriding,curing bone nonunion,repairing the soft tissue defects and restore the extremity length can be achieved by ilizarov technique for patients with infected bone defect of tibia,and the outcomes of primary operation are satisfactory.