Iliza rov骨搬移技术治疗下肢创伤后严重复杂感染长段骨缺损
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摘要
目的探讨应用Ilizarov骨搬移技术治疗下肢创伤后严重复杂感染长段骨缺损的临床疗效。方法选取应用Ilizarov骨搬移技术治疗的下肢创伤后严重复杂感染长段骨缺损患者37例,入院后保持开放性创口引流通畅,控制急性感染,分次扩创。按照Ilizarov骨搬移技术的基本方法步骤实施,观察骨延长时间、骨愈合时间、带架时间及肢体功能恢复情况。术后按Paley骨与功能分级方法评价功能恢复程度,并采用Spearman秩相关性分析患者骨缺损长度、带架时间、骨延长时间与骨愈合时间、功能恢复程度的相关性。结果有1例患者因依从性差、放弃治疗,2例患者分别因皮肤鳞癌变和反复软组织溃疡而截肢。有5例尚在康复治疗中,另29例骨缺损得以修复,肢体得到挽救,功能大部分得以恢复。29例患者Paley评级:优7例,良13例,可7例,差2例,优良率为69.0%。Spearman秩相关性分析显示骨缺损长度、带架时间、骨延长时间与骨愈合时间均呈正相关(r=0.615、0.987和0.515,均P<0.01),与功能恢复程度均呈负相关(r=-0.519、-0.740和-0.619,均P<0.01)。结论 Ilizarov骨搬移技术具有简便、实用、效果显著等优点,是目前治疗下肢创伤后严重复杂感染长段骨缺损、挽救肢体并最大限度恢复功能的常用方法,值得临床普及和推广。
Objective To evaluate the efficacy of Ilizarov bone-slipping technique in treatment of severe complex long bone defects after lower extremity trauma. Methods The clinical data of 37 patients with severe complex long bone defects after lower extremity trauma admitted between August 2010 and October 2017 were analyzed retrospectively. All patients received open wound drainage, acute infection control and open debridement after admission. According to the basic steps the Ilizarov bone-slipping was performed. Bone lengthening time,bone healing time, the time of external fixator and the degree of functional recovery were recorded. The functional evaluation was carried out according to Paley rating and the correlation was analyze by Spearman test. Results Among 37 patients, 1 patient had given up treatment for poor compliance, 2 patients had amputated for skinny scale cancer and unhealed soft tissue antrum, and 5 cases were still under the rehabilitation.In 29 cases the bone defects were repaired, limb was saved, and most function was restored; the Paley rating of them were excellent in 7 cases,good in 13 cases, fair in 7 cases and poor in 2 cases, with an excellent and good rate of 69.0%. Spearman rank correlation analysis showed that the length of bone defects was positively correlated with bone healing time(r=0.615, P< 0.01), negatively correlated with the degree of functional recovery(r=-0.519, P <0.01). The time of external fixator was positively correlated with bone healing time(r= 0.987, P <0.01), negatively correlated with the degree of functional recovery(r=-0.740, P<0.01). Bone lengthening time was positively correlated with bone healing time(r=0.515, P<0.01), negatively correlated with the degree of functional recovery(r=-0.619, P<0.01). Conclusion Ilizarov bone-slipping is relative simple, practical and significant effective in treatment of severe complex long bone defects after lower extremity trauma, which can save limbs and restore function maximally and worth of clinical application.
Objective To evaluate the efficacy of Ilizarov bone-slipping technique in treatment of severe complex long bone defects after lower extremity trauma. Methods The clinical data of 37 patients with severe complex long bone defects after lower extremity trauma admitted between August 2010 and October 2017 were analyzed retrospectively. All patients received open wound drainage, acute infection control and open debridement after admission. According to the basic steps the Ilizarov bone-slipping was performed. Bone lengthening time,bone healing time, the time of external fixator and the degree of functional recovery were recorded. The functional evaluation was carried out according to Paley rating and the correlation was analyze by Spearman test. Results Among 37 patients, 1 patient had given up treatment for poor compliance, 2 patients had amputated for skinny scale cancer and unhealed soft tissue antrum, and 5 cases were still under the rehabilitation.In 29 cases the bone defects were repaired, limb was saved, and most function was restored; the Paley rating of them were excellent in 7 cases,good in 13 cases, fair in 7 cases and poor in 2 cases, with an excellent and good rate of 69.0%. Spearman rank correlation analysis showed that the length of bone defects was positively correlated with bone healing time(r=0.615, P< 0.01), negatively correlated with the degree of functional recovery(r=-0.519, P <0.01). The time of external fixator was positively correlated with bone healing time(r= 0.987, P <0.01), negatively correlated with the degree of functional recovery(r=-0.740, P<0.01). Bone lengthening time was positively correlated with bone healing time(r=0.515, P<0.01), negatively correlated with the degree of functional recovery(r=-0.619, P<0.01). Conclusion Ilizarov bone-slipping is relative simple, practical and significant effective in treatment of severe complex long bone defects after lower extremity trauma, which can save limbs and restore function maximally and worth of clinical application.
引文
[1]Sahu RL,Ranjan R.Treatment of complex nonunion of the shaft of the tibia using Ilizarov technique and its functional outcome[J].Niger Med J,2016,57(2):129-133.DOI:10.4103/0300-1652.182076.
[2]Yin P,Zhang L,Li T,et al.Infected nonunion of tibia and femur treated by bone transport[J].J Orthop Surg Res,2015,10:49.DOI:10.1186/s13018-015-0189-5.
[3]Varsegova TN,Shchudlo NA,Shchudlo MM,et al.The effects of tibial fracture and Ilizarov osteosynthesis on the structural reorganization of sciatic and tibial nerves during the bone consolidation phase and after fixator removal[J].Strategies Trauma Limb Reconstr,2015,10(2):87-94.DOI:10.1007/s11751-015-0227-1.
[4]Stogov MV,Emanov AA,Stepanov MA.Muscle metabolism during tibial lengthening with regular and high distraction rates[J].J Orthop Sci,2014,19(6):965-972.DOI:10.1007/s00776-014-0627-y.
[5]袁宇,舒衡生,师红立.X线联合超声对肢体延长术的监测价值[J].中国临床医学影像杂志,2011,22(1):27-30.DOI:10.3969/j.issn.1008-1062.2011.01.008.
[6]艾田,张俊德,程添栋,等.伊里扎诺夫技术修复兔胫骨骨缺损成骨机制的研究[J].临床骨科杂志,2012,15(2):202-204.DOI:10.3969/j.issn.1008-0287.2012.02.038.
[7]常非,于庆巍,刘光耀,等.骨延长速度对成骨过程的影响[J].中国组织工程研究与临床康复,2010,14(39):7268-7272.DOI:10.3969/j.issn.1673-8225.2010.39.012.
[8]Abuomira IE,Sala F,Elbatrawy Y,et al.Distraction osteogenesis for tibial nonunion with bone loss using combined Ilizarov and Taylor spatial frames versus a conventional circular frame[J].Strategies Trauma Limb Reconstr,2016,11(3):153-159.DOI:10.1007/s11751-016-0264-4.
[9]Emara KM,Ghafar KA,Al KMA.Methods to shorten the duration of an external fixator in the management of tibial infections[J].World J Orthop,2011,2(9):85-92.DOI:10.5312/wjo.v2.i9.85.
[10]Kenawey M,Krettek C,Liodakis E,et al.Insufficient bone regenerate after intramedullary femoral lengthening:risk factors and classification system[J].Clin Orthop Relat Res,2011,469(1):264-273.DOI:10.1007/s11999-010-1332-6.
[11]Farr S,Mindler G,Ganger R,et al.Bone Lengthening in the Pediatric Upper Extremity[J].J Bone Joint Surg Am,2016,98(17):1490-1503.DOI:10.2106/JBJS.16.00007.
[12]Meselhy MA,Singer MS,Halawa AM,et al.Gradual fibular transfer by ilizarov external fixator in post-traumatic and post-infection large tibial bone defects[J].Arch Orthop Trauma Surg,2018,138(5):653-660.DOI:10.1007/s00402-018-2895-z.
[2]Yin P,Zhang L,Li T,et al.Infected nonunion of tibia and femur treated by bone transport[J].J Orthop Surg Res,2015,10:49.DOI:10.1186/s13018-015-0189-5.
[3]Varsegova TN,Shchudlo NA,Shchudlo MM,et al.The effects of tibial fracture and Ilizarov osteosynthesis on the structural reorganization of sciatic and tibial nerves during the bone consolidation phase and after fixator removal[J].Strategies Trauma Limb Reconstr,2015,10(2):87-94.DOI:10.1007/s11751-015-0227-1.
[4]Stogov MV,Emanov AA,Stepanov MA.Muscle metabolism during tibial lengthening with regular and high distraction rates[J].J Orthop Sci,2014,19(6):965-972.DOI:10.1007/s00776-014-0627-y.
[5]袁宇,舒衡生,师红立.X线联合超声对肢体延长术的监测价值[J].中国临床医学影像杂志,2011,22(1):27-30.DOI:10.3969/j.issn.1008-1062.2011.01.008.
[6]艾田,张俊德,程添栋,等.伊里扎诺夫技术修复兔胫骨骨缺损成骨机制的研究[J].临床骨科杂志,2012,15(2):202-204.DOI:10.3969/j.issn.1008-0287.2012.02.038.
[7]常非,于庆巍,刘光耀,等.骨延长速度对成骨过程的影响[J].中国组织工程研究与临床康复,2010,14(39):7268-7272.DOI:10.3969/j.issn.1673-8225.2010.39.012.
[8]Abuomira IE,Sala F,Elbatrawy Y,et al.Distraction osteogenesis for tibial nonunion with bone loss using combined Ilizarov and Taylor spatial frames versus a conventional circular frame[J].Strategies Trauma Limb Reconstr,2016,11(3):153-159.DOI:10.1007/s11751-016-0264-4.
[9]Emara KM,Ghafar KA,Al KMA.Methods to shorten the duration of an external fixator in the management of tibial infections[J].World J Orthop,2011,2(9):85-92.DOI:10.5312/wjo.v2.i9.85.
[10]Kenawey M,Krettek C,Liodakis E,et al.Insufficient bone regenerate after intramedullary femoral lengthening:risk factors and classification system[J].Clin Orthop Relat Res,2011,469(1):264-273.DOI:10.1007/s11999-010-1332-6.
[11]Farr S,Mindler G,Ganger R,et al.Bone Lengthening in the Pediatric Upper Extremity[J].J Bone Joint Surg Am,2016,98(17):1490-1503.DOI:10.2106/JBJS.16.00007.
[12]Meselhy MA,Singer MS,Halawa AM,et al.Gradual fibular transfer by ilizarov external fixator in post-traumatic and post-infection large tibial bone defects[J].Arch Orthop Trauma Surg,2018,138(5):653-660.DOI:10.1007/s00402-018-2895-z.
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