带血管蒂的腓骨瓣移植和Ilizarov外固定骨牵引术治疗胫骨骨缺损骨不连的比较

目的 分析比较带血管蒂的腓骨瓣移植和Ilizarov外固定骨牵引术治疗胫骨骨缺损骨不连的疗效.方法 回顾性分析2009年5月至2013年5月我们收治的64例胫骨骨缺损骨不连患者的病例资料.2009年5月至2012年4月对30例患者采用Ilizarov外固定骨牵引术治疗(骨牵引术组);2012年5月至2013年5月对34例患者采用带血管蒂的腓骨瓣移植术治疗(腓骨瓣移植术组).对两组患者医疗指标和Johner-Wruhs胫骨干骨折疗效评价标准进行比较.结果 与腓骨瓣移植术组比较,骨牵引术组患者的手术时间、住院时间更短,差异均有统计学意义(均P<0.05);但腓骨瓣移植术组的愈合时间较骨牵引术组明显缩短,差异有统计学意义(P<0.05).两组患者的并发症发生率差异无统计学意义(P>0.05).治疗后的Johner-Wruhs评分,腓骨瓣移植术组优良率为82.4%(28/34),骨牵引术组为60.0%(18/30),差异有统计学意义(P<0.05).结论 对比Ilizarov外固定骨牵引术,带血管蒂的腓骨瓣移植术治疗胫骨骨缺损骨不连患者具有骨折愈合时间短、疗效更佳的特点,但是其手术时间以及住院时间均显著延长.

Comparison of the effect of transplantation of fibula flap with vascular pedicle vs. Ilizarov external fixation in the treatment of nonunion of tibial bone defect

Objective To analyze and compare the curative effect of transplantation of fibula flap with vascular pedicle vs. Ilizarov external fixation in the treatment of nonunion of tibia bone defect. Methods The clinical data of 64 patients with nonunion of tibial bone defect from May 2009 to May 2013 were analyzed retro-spectively. From May 2009 to April 2012, 30 patients were given Ilizarov external fixation and bone traction therapy (bone traction group); from May 2012 to May 2013, 34 patients were subjected to vascularized fibula flap transplantation (fibula flap transplantation group). The medical indicators and Johner-Wruhs tibial shaft fracture efficacy evaluation criteria were compared between two groups. Results As compared with fibula flap transplantation group, operative time and hospital stay were significantly shortened in bone traction group ( P<0.05). There was no significant difference in the incidence of complications between two groups (P>0.05). The healing time was significantly reduced in the fibula flap transplantation group as compared with bone traction group (P<0.05). For the Johner-Wruhs score after treatment, the excellent rate in fibula flap transplantation group and bone traction group was 82.4%(28/34) and 60.0%(18/30), respectively (P<0.05). Conclusion As compared with the Ilizarov external fixation and bone traction, vascularized fibula flap transplantation for nonunion of bone defect of tibia bone can achieve shorter fracture healing time, and better curative effect, but significantly longer operative time and hospital stay.