發(fā)布時(shí)間：2018-04-02 14:20

  本文選題：脛骨骨不連　切入點(diǎn)：骨缺損　出處：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的回顧性分析比較骨搬移術(shù)與植骨內(nèi)固定術(shù)兩種手術(shù)方法治療脛骨骨缺損的臨床療效,比較兩種手術(shù)方式的優(yōu)缺點(diǎn),并討論各自的禁忌證、適應(yīng)證、并發(fā)癥,為臨床脛骨骨缺損的治療提供決策參考。方法回顧性分析廣西醫(yī)科大學(xué)第一附屬醫(yī)院自2005年6月至2015年2月分別采用脛骨骨搬移術(shù)(骨搬移組15例)和植骨內(nèi)固定術(shù)(植骨內(nèi)固定組22例)治療的脛骨骨缺損病例,對骨搬移組進(jìn)行7個月～15個月隨訪,植骨內(nèi)固定組進(jìn)行3.2個月～10個月隨訪。比較兩種方法修復(fù)骨缺損長度、手術(shù)切口長度、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后管理、骨折臨床愈合率及愈合時(shí)間、并發(fā)癥及住院時(shí)間、住院費(fèi)用,分析兩種方法的優(yōu)缺點(diǎn)及各自最佳的適應(yīng)證。結(jié)果兩組37例病例均獲得隨訪,骨搬移組平均隨訪10.7個月,植骨內(nèi)固定組平均隨訪6.4個月。兩組病例在手術(shù)切口長度、手術(shù)時(shí)間、術(shù)中出血量、骨折臨床愈合時(shí)間、住院時(shí)間、住院費(fèi)用方面有統(tǒng)計(jì)學(xué)差異(P0.05),骨搬移組手術(shù)切口較短、術(shù)中出血量較少,但手術(shù)時(shí)間、骨折愈合時(shí)間、住院時(shí)間均較長,住院費(fèi)用也相對較高。骨搬移組修復(fù)骨缺損長度2.5～14cm,平均(6.3±3.4)cm,4例搬移對合處發(fā)生了骨不連,予取自體骨植骨治療后愈合,4例出現(xiàn)不同程度的足下垂畸形,4例出現(xiàn)釘?shù)栏腥?4例出現(xiàn)疼痛,骨折臨床愈合率73.3%；植骨內(nèi)固定組修復(fù)了骨缺損2.3-4.2cm,平均(3.1±0.5)cm,有6例再次出現(xiàn)骨端不愈合,其中3例經(jīng)再次自體骨植骨后骨性愈合,3例經(jīng)骨搬移后愈合,有1例出現(xiàn)取骨區(qū)感染,二期清創(chuàng)后好轉(zhuǎn),有1例出現(xiàn)手術(shù)切口感染,抗炎治療后好轉(zhuǎn),5例出現(xiàn)疼痛,骨折臨床愈合率72.7%,有6例患者仍有0.8～1.5cm左右的患肢短縮存在。結(jié)論骨搬移術(shù)和植骨內(nèi)固定術(shù)兩種方法均能達(dá)到有效的治療,二者各有優(yōu)勢：骨搬移術(shù)無需植骨,減少取骨植骨的并發(fā)癥,對大段骨缺損有著療效確切,對軟組織要求相對較低,另外對慢性骨髓炎也可以達(dá)到有效的治療。植骨內(nèi)固定組對小段骨缺損的療效確切,手術(shù)操作簡單,并發(fā)癥相對少。
[Abstract]:Objective to compare the clinical effects of bone transfer and internal fixation in the treatment of tibial bone defect, compare the advantages and disadvantages of the two surgical methods, and discuss their contraindications, indications and complications.To provide a reference for clinical treatment of tibial bone defect.Methods from June 2005 to February 2015, the cases of tibial bone defect treated by tibial bone transfer (15 cases in bone transfer group) and internal fixation (22 cases in bone graft fixation group) were retrospectively analyzed in the first affiliated Hospital of Guangxi Medical University.The bone transfer group was followed up from 7 months to 15 months, and the bone graft fixation group was followed up from 3.2 months to 10 months.The length of bone defect, the length of incision, the time of operation, the amount of intraoperative bleeding, the postoperative management, the rate of fracture healing and healing time, the complications and hospital stay, the cost of hospitalization were compared between the two methods.The advantages and disadvantages of the two methods and their best indications were analyzed.Results 37 cases in both groups were followed up. The average follow-up was 10.7 months in the bone transfer group and 6.4 months in the internal fixation group.There were significant differences in incision length, operative time, intraoperative bleeding amount, fracture healing time, hospitalization time and hospitalization cost between the two groups (P 0.05). The operative incision was shorter and the amount of intraoperative bleeding was less in the bone transfer group, but the operative time was less.Fracture healing time, hospital stay longer, hospitalization costs are relatively high.In the bone transfer group, the length of repair bone defect was 2.514 cm, the average length of bone defect was 6.3 鹵3.4 cm ~ (-1), 4 cases had nonunion, 4 cases had healing after bone grafting, 4 cases had nail tract infection and 4 cases had pain.After secondary debridement, there was 1 case with incision infection and 5 cases with pain after anti-inflammatory therapy. The clinical healing rate of fracture was 72.7%. There were 6 patients with 0.8~1.5cm or so with short limb contraction.Conclusion both bone transfer and internal fixation of bone graft can achieve effective treatment. The two methods have their own advantages: there is no need for bone grafting, and the complications of bone grafting are reduced, which is effective for large segment bone defect.Soft tissue requirements are relatively low, in addition to chronic osteomyelitis can achieve effective treatment.The internal fixation group was effective in the treatment of small bone defects, simple in operation and less in complications.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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