發(fā)布時(shí)間：2018-05-20 20:28

  本文選題：MIPPO技術(shù) + 脛骨骨不連��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的： 現(xiàn)如今骨不連已成為骨科的一大難題，它是骨折中比較常見的并發(fā)癥，發(fā)生率在骨折病例中占3.4%。一些因素，如高能量創(chuàng)傷，感染，和醫(yī)源性因素（過度剝離骨膜，血液供應(yīng)破壞，缺乏軟組織的保護(hù)）都會(huì)導(dǎo)致骨不連。脛骨骨不連患者存在許多問題：一些需要多次手術(shù)，小腿肌肉萎縮是一種常見的問題。許多患者完全失去信心，變得氣餒和沮喪。傳統(tǒng)的切開復(fù)位內(nèi)固定可導(dǎo)致多種并發(fā)癥。例如，皮膚壞死，軟組織感染，骨折不愈合或延遲骨組織已經(jīng)報(bào)道。我們采用了MIPPO技術(shù)聯(lián)合一種新的“橄欖式”樣植骨的方法治療了18例脛骨骨不連患者，對術(shù)后患者骨折愈合和患肢功能情況進(jìn)行評估。 資料與方法： 本文通過回顧性研究，自2010年至2013年我們共選取了18例患者，所有患者均為男性�；颊叩钠骄挲g為41歲（24 57年）。平均隨訪時(shí)間為10個(gè)月（3 23個(gè)月）。所有骨折均是由高能量損傷造成，包括機(jī)動(dòng)車輛事故（摩托車或汽車）或從高處墜落傷�；颊咦畛醯闹委熓鞘褂猛夤潭ò寤騼�(nèi)固定板，但6個(gè)月后，脛骨骨不連依然發(fā)生，二次手術(shù)是必然的。X線照片可見骨折斷端有硬化骨形成，髓腔閉塞，無骨小梁形成。按其骨不連發(fā)生的位置：脛骨近端（四例）；中端（四例）；遠(yuǎn)端（九例）；中下段（1例）。十例為多發(fā)性骨折，包括股骨骨折和脛腓骨粉碎性骨折，一例有神經(jīng)損傷和血管損傷，六例為脛腓骨開放性骨折。11例使用了外側(cè)板，6例使用了內(nèi)側(cè)板，，1例使用了前外側(cè)板和內(nèi)側(cè)板。 結(jié)果： 我們分別在1個(gè)月，3個(gè)月，6個(gè)月和1年對所有患者進(jìn)行影像學(xué)檢查，并對影像學(xué)結(jié)果進(jìn)行了評估。功能結(jié)果評分：優(yōu)14例，良四例。并不需要二次手術(shù)。平均手術(shù)時(shí)間為75分鐘（60 85分鐘），術(shù)中照射時(shí)間為20秒（10 30秒）。所有患者在大約13周時(shí)再影像學(xué)上均獲得了堅(jiān)固的愈合（4 24周）。術(shù)后隨訪23個(gè)月。隨訪期內(nèi)未見明顯骨壞死骨，并且總出血量大約為80 130毫升。 結(jié)論： MIPPO技術(shù)聯(lián)合“橄欖式”植骨的手術(shù)方法在對脛骨骨不連的治療上，可以很好地保護(hù)血運(yùn)，促進(jìn)骨折的愈合，并且手術(shù)的成功率是非常高的，隨訪期間，我們患者沒有肢體疼痛，畸形，內(nèi)固定失敗，感染，血管或神經(jīng)損傷，或皮膚壞死，初步證明了這種方法在治療脛骨骨不連上是一種安全、有效的方法。
[Abstract]:Objective: Nowadays, nonunion has become a major problem in orthopedic department. It is a common complication in fracture, accounting for 3.4% of fracture cases. Some factors, such as high-energy trauma, infection, and iatrogenic factors (excessive exfoliation of periosteum, blood supply disruption, lack of soft tissue protection) can lead to nonunion. There are many problems in patients with tibial nonunion: some require multiple surgeries and leg muscle atrophy is a common problem. Many patients lose confidence completely and become discouraged and depressed. Traditional open reduction and internal fixation can lead to multiple complications. For example, skin necrosis, soft tissue infections, nonunion or delayed bone tissue have been reported. MIPPO technique combined with a new "olive-like" bone graft was used to treat 18 patients with tibial nonunion. Fracture healing and limb function were evaluated. Information and methods: From 2010 to 2013, we selected 18 patients, all of whom were male. The average age of the patients was 41 years old, 24 years and 57 years. The average follow-up time was 10 months and 23 months. All fractures are caused by high-energy injuries, including motor vehicle accidents (motorcycles or cars) or falls from high altitudes. The first treatment was external fixation or internal fixation, but after 6 months, nonunion of tibia still occurred. The second operation was inevitable. X-ray photos showed that the broken end of fracture had sclerosing bone formation, medullary cavity occlusion, and no trabeculae formation. According to the position of nonunion, the proximal tibia (4 cases), the middle end (4 cases), the distal end (9 cases), the middle and lower segment of the tibia (1 case). Ten cases were multiple fractures, including femoral fractures and comminuted fractures of tibia and fibula, and one case had nerve and vascular injuries. 6 cases of open fracture of tibia and fibula. 11 cases were treated with lateral plate. 6 cases used medial plate and 1 case used anterolateral plate and medial plate. Results: We evaluated the imaging findings of all patients at 1 month, 3 months, 6 months and 1 year. Functional score: excellent in 14 cases, good in 4 cases. There is no need for secondary surgery. The average operative time was 75 minutes, 60 minutes, 85 minutes, and the intraoperative irradiation time was 20 seconds, 10 minutes and 30 seconds. All patients received solid healing at about 13 weeks after re-imaging. Postoperative follow-up was 23 months. No osteonecrosis was found during the follow-up period, and the total bleeding was about 80 to 130 ml. Conclusion: The MIPPO technique combined with "olive-type" bone grafting in the treatment of tibial nonunion can well protect blood flow and promote fracture healing, and the success rate of the operation is very high, and during the follow-up period, our patients had no limb pain. Malformation, failure of internal fixation, infection, vascular or nerve injury, or skin necrosis have proved to be a safe and effective method for the treatment of tibial nonunion.
【學(xué)位授予單位】：吉林大學(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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相關(guān)期刊論文 前3條

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本文編號：1916105